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

Abstract

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.

Non–IgE- or Mixed IgE/Non–IgE-Mediated Gastrointestinal Food Allergies in the First Years of Life: Old and New Tools for Diagnosis

“…The study also showed that some symptoms, such as skin involvement, were more frequently observed in children with confirmed allergy whose score was significantly higher. The authors therefore concluded that the systematic evaluation of symptoms associated with CoMiSS can aid the selection of infants who might benefit from an elimination diet [147,148].…”

Symptom scores in the diagnosis of pediatric cow’s milk protein allergy: A systematic review

“…Four studies scored high risk in the patient selection domain: two used a case‐control study design, 16,21 and two selected only infants that scored a CoMiSS™ of >12 22,23 . Four studies scored high risk for 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 16,22–24 . All studies scored high risk of bias for not using DBPCFC as the reference standard 16,21–26 .…”

“…However, the reported accuracy estimates are likely to overestimate the real performance of the score, first because response to elimination diet was defined as a decrease in the CoMiSS™ score (incorporation bias) and the cut‐off of 9 was based on ROC analysis. Selbuz evaluated CoMiSS™ against OFC in infants 0–12 months with an initial CoMiSS™ ≥12 22 . Reported sensitivity and specificity estimates based on ROC analysis have not been included.…”

“…Selbuz evaluated CoMiSS™ against OFC in infants 0-12 months with an initial CoMiSS™ ≥12. 22 Reported sensitivity and specificity estimates based on ROC analysis have not been included. Given that all children with CoMiSS™ <12 were excluded in the selection process without follow-up, and, that children with an improvement in CoMiSS™ <3 after elimination diet did not undergo food challenge, it is unclear what use of the test the reported estimates are referring to.…”

“…22,23 Four studies scored high risk for 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. 16,[22][23][24] All studies scored high risk of bias for not using DBPCFC as the reference standard. 16,[21][22][23][24][25][26] All studies scored high risk of bias for flow and timing: one left an interval of up to 3 months between applying CoMiSS™ and conducting OFC, 25 three inappropriately excluded infants from the analysis, 22 and three used different reference standards to establish CMPA.…”