Testing the Cow’s Milk-Related Symptom Score (CoMiSSTM) for the Response to a Cow’s Milk-Free Diet in Infants: A Prospective Study

Salvatore, Silvia; Bertoni, E.; Bogni, Federica; Bonaita, Valentina; Armano, Chiara; Moretti, Alex; Baù, Mario; Luini, C.; D’Auria, Enza; Marinoni, Maddalena; Zuccotti, Gianvincenzo; Agosti, Massimo

doi:10.3390/nu11102402

Cited by 35 publications

(72 citation statements)

References 25 publications

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“…According to the analysis of the data obtained in a population of presumed healthy infants, a score of >10 was proposed as the best cut-off value [2]. A recent Italian study evaluated the CoMiSS in symptomatic infants, proposing a cut-off of >9 [5]. According to the data from Poland, the 95th percentile was 11 [3].…”

Section: Discussionmentioning

confidence: 99%

“…According to the data from Poland, the 95th percentile was 11 [3]. The receiver operation characteristic curve identified a CoMiSS of 9 to be the best cut-off value (84% sensitivity, 85% specificity, 80% positive (PPV), and 88% negative predictive value (NPV)) for the response to a cow milk free diet [5]. Whatever cut-off considered, only 1 patient in the Spanish cohort changed from positive to negative i.e., 1 out of 13 for ≥10 limit.…”

Section: Discussionmentioning

confidence: 99%

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The Cow’s Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability

et al. 2020

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The Cow’s Milk-related Symptom Score (CoMiSSTM) was created as an awareness tool for cow’s milk allergy. The aim of the present study was to analyze the inter-rater variability between a pediatrician, parents, and day to day variability. A Health Care Professional (HCP) and parent filled in the CoMiSS independently and blinded for each other to evaluate inter-rater variability. In order to validate day-to-day variability, a parent filled in the CoMiSS during 3 consecutive days and was compared to the CoMiSS scored by the HCP. The absolute agreement between parent and HCP was 75%, and 92.6% and 100% with a tolerance of 0, 1, and 2 points, respectively, resulting in excellent agreement with an intraclass correlation coefficient (ICC) 0.981 (95% Confidence Interval 0.974–0.986, p < 0.001). Day-to-day variability during 3 consecutive days resulted in an absolute agreement of 30%, increasing to 80% and 88.6% when 2 and 3 points, respectively, were accepted. The ICC was excellent for the parental prospective scores (0.93, 95% CI 0.90–0.96; p < 0.001). Day-to-day variability indicates that CoMiSS has a moderate inter-rater reliability. A very low variability was observed when scored prospectively over three days. Data suggest that the CoMiSS can reliably be scored by parents without additional training.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Cow’s Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability

et al. 2020

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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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“…As for the use of the CoMiSS™, Salvatore et al recently proposed a cut-off of nine to consider the score as positive [30]. The authors highlighted 84% in sensitivity, and 85% specificity for the score, with a 80% positive and 88% negative predictive value.…”

Section: Discussionmentioning

confidence: 99%

May Failure to Thrive in Infants Be a Clinical Marker for the Early Diagnosis of Cow’s Milk Allergy?

Diaferio

Caimmi

Verga³

et al. 2020

Nutrients

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Objectives—Failure to thrive (FTT) in infants is characterized by growth failure. Although, cow’s milk allergy (CMA) may have an impact on growth and leads to FTT, data are still limited. We focused on FTT as a possible clinical marker for an early diagnosis of CMA. The aim of the present study was to evaluate the implications of cow’s milk hypersensitivity in infants with FTT and the growth catch-up after a cow’s milk-free diet (CMFD). Methods—A cross-sectional study of all consecutive infants evaluated at the Pediatric Nutrition and Allergy Unit of the University Hospital of Bari (Italy) from January 2016 to April 2018 with a medical-driven diagnosis of FTT. Eligible infants were investigated for possible IgE mediated or non-IgE mediated CMA. Results—43 infants were included, mean age 5.7 months. 33/43 (77%) FTT presented a CMA related disease: 3/43 (7%) were diagnosed as presenting an IgE mediated CMA, 30 (93%) had a non IgE-mediated CMA, confirmed by the elimination diet for diagnostic purposes, that led to a significant improvement of symptoms and recrudescence after milk reintroduction. A total of 29 out of 30 patients (one patient was lost at follow-up) moved up to their original growth percentile after dietary changes. Growth z-scores were computed based on WHO anthropometric data. In 10 out of 43 patients (23%) were diagnosed with gastro-esophageal reflux disease (GERD). Conclusions—when evaluating an infant with FTT, physicians should include in their evaluation an extensive search for IgE mediated and non IgE mediated CMA. When in vivo and in vitro analysis are not conclusive, a 4- to 8-weeks trial of CMFD and a consecutive re-introduction of milk proteins may be helpful in less common diagnoses.

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Testing the Cow’s Milk-Related Symptom Score (CoMiSSTM) for the Response to a Cow’s Milk-Free Diet in Infants: A Prospective Study

Cited by 35 publications

References 25 publications

The Cow’s Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability

The Cow’s Milk-Related Symptom Score (CoMiSSTM): Health Care Professional and Parent and Day-to-Day Variability

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

May Failure to Thrive in Infants Be a Clinical Marker for the Early Diagnosis of Cow’s Milk Allergy?

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