Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Pediatr Pulmonol. 2019 Nov;54(11):1781-1786. doi: 10.1002/ppul.24463. Epub 2019 Jul 25.
A variety of inhaled antigens have been implicated to cause hypersensitivity pneumonitis (HP). We observed that children force-fed with lentil-based weaning food had persistent respiratory symptoms and radiology similar to HP.
To describe the clinical features of lentil HP.
We conducted a retrospective review of records of children with lentil HP attending Pediatric Chest Clinic at a tertiary care hospital in North India from 2008-2018. We included case records with elevated immunoglobulin G (IgG) specific for lentil antigen.
Nine children (seven boys) were identified with median (IQR) age of onset of symptoms and diagnosis at 9 (6, 12) and 11 (10, 16) months, respectively. Chronic cough (100%), shortness of breath (89%), fever (78%), vomiting (56%), and wheezing (33%) were common symptoms. Fine crackles were heard in 33% of children, none had clubbing. CT scans showed nodular opacities and consolidation in 78% and 67% children, respectively. Bronchoalveolar lavage showed increased neutrophils and lymphocytes (67% and 33%, respectively). All children showed rapid remission with systemic steroids (prednisolone), starting at a median dose of 1 (1, 1.1) mg kg day . One child had a clinical relapse which was treated with oral steroids again. IgG specific to lentil antigens was elevated in children with lentil HP (21->200 mgA/L) compared with children with other chronic respiratory illnesses (n = 7, <2-11.4 mgA/L).
Lentil aspiration is an important cause of HP in infants of weaning age with force-feeding practices. Further studies are needed to identify aspirated antigens which cause HP in aspiration prone children.
多种吸入性抗原已被认为可引起过敏性肺炎（HP）。我们观察到，用豆基断奶食品强制喂养的儿童出现持续的呼吸道症状和类似于 HP 的影像学表现。
描述豆 HP 的临床特征。
我们对 2008 年至 2018 年期间在印度北部一家三级保健医院的儿科胸科诊所就诊的豆 HP 患儿的病历进行了回顾性分析。我们纳入了对豆抗原特异性 IgG 升高的病例记录。
确定了 9 名儿童（7 名男孩），其症状和诊断的中位（IQR）发病年龄分别为 9（6、12）和 11（10、16）个月。慢性咳嗽（100%）、呼吸急促（89%）、发热（78%）、呕吐（56%）和喘息（33%）是常见症状。33%的儿童可闻及细湿啰音，无杵状指。78%和 67%的儿童 CT 扫描分别显示结节性混浊和实变。支气管肺泡灌洗液显示中性粒细胞和淋巴细胞增多（分别为 67%和 33%）。所有儿童均接受全身皮质类固醇（泼尼松龙）治疗，起始剂量中位数为 1（1、1.1）mg/kg/d，迅速缓解。1 例儿童出现临床复发，再次给予口服皮质类固醇治疗。与患有其他慢性呼吸道疾病的儿童（n=7，<2-11.4mgA/L）相比，患有豆 HP 的儿童的豆抗原特异性 IgG 升高（21->200mgA/L）。
在有强制喂养习惯的断奶期婴儿中，豆吸入是 HP 的一个重要原因。需要进一步研究以确定在易发生吸入的儿童中引起 HP 的吸入性抗原。
