1. Lentil aspiration leading to likely hypersensitivity pneumonitis.
- Author
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Dhochak N, Jat KR, Lodha R, and Kabra SK
- Subjects
- Alveolitis, Extrinsic Allergic diagnostic imaging, Alveolitis, Extrinsic Allergic immunology, Bronchoalveolar Lavage Fluid cytology, Bronchoalveolar Lavage Fluid immunology, Female, Humans, Immunoglobulin G immunology, India, Infant, Leukocyte Count, Lung diagnostic imaging, Lung immunology, Male, Respiratory Aspiration diagnostic imaging, Respiratory Aspiration immunology, Retrospective Studies, Thorax diagnostic imaging, Tomography, X-Ray Computed, Alveolitis, Extrinsic Allergic etiology, Lens Plant immunology, Respiratory Aspiration complications
- Abstract
Rationale: 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., Objectives: To describe the clinical features of lentil HP., Methods: 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., Measurements and Main Results: 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
-1 day-1 . 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)., Conclusions: 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., (© 2019 Wiley Periodicals, Inc.)- Published
- 2019
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