Roentgenologic Manifestations in the Lungs in Milk Allergyl

Abstract

Asyndrome of chronic recurring upper respiratory and pulmonary infections apparently associated with ingestion of milk and milk products has been described by Heiner and Sears (1). It was felt advisable to call attention to the chest involvement and its roentgenologic manifestations in this condition. Unusually high levels of precipitating antibodies to various cow's milk proteins were found by the workers cited above in the serum of infants with chronic respiratory disease. More than 2,000 patients were tested at random for the presence of these antibodies by exposing their sera to raw milk antigen by a modified double diffusion agar-in-gel technic (2). In 8 cases,3 all in infants, 5 or more precipitation bands were demonstrated and severe clinical manifestations were present. Four of the group were shown by one of us (W. T. K.) to have strongly suggestive or positive laboratory evidence of idiopathic pulmonary hemosiderosis. Clinically, the children described by Heiner and Sears had recurring or continuous episodes of coryza, cough, wheezing, and pneumonia. They displayed also gastrointestinal manifestations of varying degrees, as vomiting, diarrhea, abdominal pain, and poor weight gain. These findings were associated with the ingestion of cow's milk products. The age of onset of symptoms varied from thirteen days to sixteen months, being at or under four months in all but 1 child. In 7 of the children there was no evidence of tuberculous or fungous infection. In 1 a healed primary complex was demonstrated on the chest roentgenogram, but old tuberculin (5 T.U.) and histoplasmin (1:100) skin tests were negative at forty-eight hours in all. Cystic fibrosis was also ruled out. The accompanying graph (Fig. 1) illustrates the incidence of the various clinical manifestations of the syndrome in 7 of the 8 patients. The eighth child was never completely evaluated because all attempts to induce his family to bring him back to the hospital after the first visit were futile. His history included cough of one week duration, tachypnea, fever, anorexia, and vomiting. He was pale and irritable, and exhibited physical signs of pneumonia; anemia, leukocytosis, and marked eosinophilia were present. The natural course of this disease is not definitely known, since recognition and treatment of the first case are of such recent date, the autumn of 1959. Three patients became asymptomatic spontaneously at the ages of fourteen, twenty-one, and thirty months, even though circulating precipitating antibodies were still present. In 4 patients still symptomatic, the withdrawal of milk products and, to a lesser extent, boiling of the milk before feeding improved or completely cleared the symptoms. One child of the last group was still having symptoms at thirty months of age, but became asymptomatic on milk substitute.