Sasha is 20 weeks old. She developed a dry cough, breathing difficulties with intermittent wheezing at 16 weeks. She was taken to see the local G.P who examined her and suspected Sasha might be having bronchiolitis. She was given paracetamol and ibuprofen syrups and sent home. She continued to cough, and occasionally vomits coffee brown material, with intermittent fever.
On a second visit to the doctor, she was given amoxycillin antibiotics for chest "infection".
Sasha continues to deteriorate and progressively lost weight. She was then referred by her painstaking G.P who, suspected "something very unusual" to a pediatrician in the local teaching hospital.
A careful history, physical examination and food diary revealed that Sasha is only on cow's milk and symptoms tend to worsen after meals. A cow milk allergy test came back positive. The diagnosis of Heiner syndrome was clinched.
Sasha symptoms disappeared within a week of stopping cow's milk!
Often not commonly recognized by doctors, this disease manifests usually after the age of 3 months up to 3 years, characterized by unexplained coughing and wheeze in a child who may actually cough out blood, vomit, with associated colicky abdominal pain.
Recurrent fever, ear pain, breathlessness, passage of loose stools and even blood in the stool of the infant leading to iron deficiency anemia and failure to thrive or grow are all symptoms that should alert the physician to the presence of Heiner syndrome in a baby.
This syndrome is caused by the child’s immune system recognizing the components of cow milk as foreign, thus develops antibody to the cow milk, in a bid to destroy and neutralize the perceived dangerous effect of cow milk. Unfortunately, the antibodies produced also damages the lungs of the child, leading to the deposition of what doctors describes as haemosiderin in the lung tissue.
Diagnosis of Heiner Syndrome
A high index of suspicion, cough, difficulty in breathing in an infant or toddler, passage of blood in feces or coughing of blood plus or minus the presence of abdominal pain in any child being fed cow milk should point to this syndrome.
A simple food allergy skin prick test to cow milk usually proves positive. In severe cases, a lung biopsy may be necessary, and this will demonstrate macrophages filled with haemosiderin, IgA and IgG deposits as well as compliment factor three C3.
If you suspects that your child may be having food allergy, you can order a skin prick allergy test kit from a leading laboratory approved in the UK for food allergy testing, YORKTEST Labouratories UK .
If you are in the USA or Canada, you can get similar allergy testing kit from a FDA approved home allergy testsHome Health Testing®
Like in all cases of food allergy, elimination of the trigger, in this case cow milk usually leads to resolution of symptoms, and the child recovers.
So, is your child struggling to eat, coughing, with colicky abdominal pain and coughing blood or passing blood in his or her stool as well as having breathing problems and being treated as bronchiolitis or asthma or chest infection by doctors? Could this child be having Heiner syndrome? Go back and discuss this possibility with your doctor.
- Moissidis I, Chaidaroon D, Vichyanond P, Bahna SL.
Milk-induced pulmonary disease in infants (Heiner syndrome).Pediatr Allergy Immunol. 2005 Sep; 16(6):545-52.
- A Clinical Approach to Medicine By Yong Yau Ong
Published by World Scientific, 2004ISBN 9812560734, 97898125607351608 pages
Return to Causes of Abdominal Pain in Children from "Heiner Syndrome"
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