Heiner syndrome and correlation with food allergy

Heiner syndrome (HS), although rare in pediatric practice, can cause cough, wheezing, and only in rare cases hemoptysis. HS should be considered in any child presenting these respiratory symptoms and radiological evidence of alveolar infiltrates, especially when accompanied by signs of food allergy-most notably cow's milk protein allergy, although other foods may also be involved. The use of probiotics should be evaluated with caution in these children. We report a case of a 1-year and 6-month-old female patient who presented at the Pneumology Clinic with a 1-day history of blood-tinged sputum. Although she had a known history of cow's milk protein allergy and well-controlled asthma, the occurrence of hemoptysis, even in small quantities, raised concerns for the family. A second episode of hemoptysis appeared when she consumed egg and probiotics. After correlating the patient's medical history with clinical, laboratory, and imaging findings, a diagnosis of HS was established. The patient received emergency treatment followed by bronchodilators, corticosteroid therapy, and a restricted diet for cow's milk protein and egg. The patient's condition improved immediately after treatment and remained stable at the 5-month follow-up. The differential diagnosis with idiopathic pulmonary hemosiderosis must not be overlooked, due to its more severe clinical course and higher risk of complications.