Assessment of Cow’s milk-related symptom scores in early identification of cow’s milk protein allergy in Chinese infants

Zeng, Yanwu; Zhang, Jiyong; Dong, Guoqing; Liu, Peihui; Xiao, Fei; Li, Weiyan; Wang, Liting; Wu, Qian-Zhen

doi:10.1186/s12887-019-1563-y

Cited by 32 publications

(66 citation statements)

References 11 publications

(14 reference statements)

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“…13,14 In these studies, infants suspected with CMPA were evaluated in paediatric gastroenterology clinics where patients with bloody stools and slow weight gain were also included, and no cut-off value was used regarding CoMiSS. 13,14 In another study by Prasad et al, 84.3% of the children were diagnosed with CMPA using CoMiSS with a cut-off value of ≥12, but the design of this study is quite different from ours. 15 In our study, using SBS ≥12 as the cut-off value and with a challenge test, 54.2% of the infants were diagnosed with CMPA.…”

Section: Discussionmentioning

confidence: 99%

Assessment of cows milk‐related symptom scoring awareness tool in young Turkish children

Selbuz

Altuntaş

Kansu

et al. 2020

J Paediatrics Child Health

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Background: The diagnosis of cows milk protein allergy (CMPA) is not always easy. Cow's Milk-related Symptom Score (CoMiSS) has been developed to raise the awareness of CMPA among the primary health-care providers. In this study, we aimed to evaluate the validity of CoMiSS as a diagnostic approach of CMPA in infants in our country. Methods: Infants with a CoMiSS of more than 12 points were included. An elimination diet was implemented in these infants for 4 weeks, and CoMiSS was reapplied. Infants with a reduction of ≥3 points in CoMiSS were considered responsive to the elimination diet, and an open oral challenge test was performed. Infants with symptom recurrence were diagnosed with CMPA. Results: The study included 168 infants. When they were included in the study, the first CoMiSS score was 13.6 AE 1.9. After the elimination diet, the number of responsive infants was 154 (91.7%). Of the infants, 91 (54.2%) were diagnosed with CMPA with positive challenge. The majority of the patients diagnosed with CMPA presented with gastrointestinal and/or dermatological symptoms (80.3%). Positive family history of allergy was more prevalent in CMPA(+) infants (P < 0.001). The mean atopic dermatitis score was higher in CMPA(+) infants (P = 0.001). Eosinophilia and cows milk-specific IgE (CM-sIgE) positivity were more prevalent in infants with CMPA (P = 0.01 and P < 0.001, respectively). Conclusions: CoMiSS is a valuable tool to evaluate CMPA in primary care. The presence of multiple symptoms, especially skin involvement, helps to recognise infants with CMPA. Family history and eosinophilia also support the diagnosis of CMPA.

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Section: Discussionmentioning

confidence: 99%

Assessment of cows milk‐related symptom scoring awareness tool in young Turkish children

Selbuz

Altuntaş

Kansu

et al. 2020

J Paediatrics Child Health

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“…The authors of this study concluded that the CoMiSS™ may be useful in the diagnosis of CMA. However, they suggested that a CoMiSS™ cutoff score of ≥12 as the criterion for the early identification of CMA may be significantly high and suggested a cut-off of ≥6, at least in Chinese infants [7]. A single-blinded, prospective, multicenter trial involving infants that is validating the sensitivity and specificity of the CoMiSS™ against open oral food challenge is ongoing [8].…”

Section: Comparison With Other Studiesmentioning

confidence: 99%

Cow's Milk-Related Symptom Score in Presumed Healthy Polish Infants Aged 0–6 Months

Bigorajska

Filipiak

Winiarska

et al. 2020

Pediatr Gastroenterol Hepatol Nutr

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Purpose: The Cow's Milk-related Symptom Score (CoMiSS™), which considers crying, regurgitation, stools, skin and respiratory symptoms, was developed as an awareness tool for evaluating cow's milk-related symptoms. The scoring ranges from 0 to 33. A score ≥12 was proposed as being likely cow's milk-related and suggestive of allergy to cow's milk. This study aimed to determine the age-related CoMiSS™ values in presumed healthy infants in Poland. Methods: This was a cross-sectional study conducted in well-child clinics in two locations. Parents of the presumed healthy infants aged ≤6 months were approached during a routine checkup/vaccination visit. The exclusion criteria were as follows: presence of acute or chronic diseases, preterm delivery, treatment with therapeutic formula, and use of any food supplements (except vitamins) or medications. Results: Data from 226 infants were obtained (median age [Q1-Q3], 4 months [3-4]). The overall median (Q1-Q3) and mean (standard deviation) CoMiSS™ values were 4 (2-7) and 4.7 (3.5), respectively. The 95th percentile was 11. Scores on some, albeit not all, components of the CoMiSS™ significantly differed between age groups (crying, stools) or feeding type groups (stools and skin symptoms). Eleven children (4.9%) scored ≥12. Conclusion: This study adds to earlier age-related CoMiSS™ data by providing CoMiSS™ values in presumed healthy infants in Poland.

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“…23 Three studies demonstrated high risk of index test interpretation bias, due to the lack of pre-specified threshold criterion for a positive screen and a lack of blinding to the results of the reference standard. 7,23,24 All six studies were at high risk of bias in the reference standard domain because the reference standard DBPCFC was not used, while, one study included the index test in the reference standard. 25 Five studies scored high risk of bias for flow and timing; one left an interval of up to 3 months between applying CoMiSS TM and conducting OFC, 25 two excluded eligible infants from the analysis, 7,23 and two used different reference standards to establish CMPA.…”

Section: Development and Piloting Studiesmentioning

confidence: 99%

“…Seven studies received funding from the pharmaceutical or milk formula industry. 13,23,24,[27][28][29][30] Main findings…”

Section: Development and Piloting Studiesmentioning

confidence: 99%

“…Test accuracy of CoMiSS TM was evaluated in 5 studies; two evaluated the accuracy of the tool to predict a positive food challenge following an elimination diet, 8,23 whilst three evaluated the test accuracy at presentation relative to results of confirmatory tests for CMPA. [24][25][26] Characteristics of the methods used to apply CoMiSS TM and reference standards used in each study are presented in Table 2. Accuracy results for each study are summarised in Table 3 and Figure 5.…”

Section: Test Accuracy Studiesmentioning

confidence: 99%

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A comprehensive evaluation of symptom scores designed to inform the triage and diagnosis of cow’s milk protein allergy in children: a systematic review of the research evidence

Thompson¹,

Zhelev²,

Peters³

et al. 2020

Preprint

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Background: Cow's milk protein allergy (CMPA) is an immune-mediated allergic response to proteins in milk, a common infant food allergy. The wide range and frequency of CMPA symptoms make diagnosis a challenge, particularly in primary care. Symptom scores may improve a clinician's awareness of symptoms, thus indicating a need for further testing. This systematic review examined the development and evaluation of such symptom scores for use in infants. Methods: Four databases were searched from inception to 3 December 2019, for diagnostic accuracy studies, randomised controlled trials, observational studies, economic evaluations, qualitative studies, and studies reporting on the development of the tools. Experts were consulted for additional studies. Data were not suitable for meta-analysis due to heterogeneity, so were narratively synthesised. Results: We found two symptom scores evaluated in one and fourteen studies, respectively. Estimated sensitivity and specificity ranged from 37-98% and 38-93%. The evaluations of each tool were at high risk of bias or failed to address issues such as clinical and cost-effectiveness. Conclusions: Estimates of accuracy of symptom scores for CMPA offered so far should be interpreted cautiously. Rigorous research based on well-defined roles for the tools and free of potential conflicts of interest is urgently required. A comprehensive evaluation of symptom scores designed to inform the triage and diagnosis of cow's milk protein allergy in children: a systematic review of the research evidence

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Assessment of Cow’s milk-related symptom scores in early identification of cow’s milk protein allergy in Chinese infants

Cited by 32 publications

References 11 publications

Assessment of cows milk‐related symptom scoring awareness tool in young Turkish children

Assessment of cows milk‐related symptom scoring awareness tool in young Turkish children

Cow's Milk-Related Symptom Score in Presumed Healthy Polish Infants Aged 0–6 Months

A comprehensive evaluation of symptom scores designed to inform the triage and diagnosis of cow’s milk protein allergy in children: a systematic review of the research evidence

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