Lentil aspiration leading to likely hypersensitivity pneumonitis

摘要

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.