The Cow’s Milk Related Symptom Score: The 2022 Update

Vandenplas, Yvan; Bajerová, Kateřina; Dupont, Christophe; Eigenmann, Philippe; Kuitunen, Mikael; Ribes-Koninckx, Carmen; Salvatore, Silvia; Shamir, Raanan; Szajewska, Hania

doi:10.3390/nu14132682

Cited by 18 publications

(18 citation statements)

References 51 publications

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“…Recently, the previously proposed cut-off point which indicates the likelihood that symptoms may be cow’s milk related was suggested to be lowered from ≥ 12 to ≥ 10. 9 …”

Section: Discussionmentioning

confidence: 99%

“…In fact, CoMiSS does contain symptoms which are IgE mediated, such as urticaria but also vomiting, diarrhea and other gastrointestinal (GI) symptoms that can be either IgE as non-IgE mediated. 9 …”

Section: Discussionmentioning

confidence: 99%

“… 8 But it was recently suggested that this cut off point be lowered from ≥12 to ≥10 with replacement of the Bristol Stool Scale (BSS) by the Brussels Infant and Toddlers Stool Scale (BITSS) as it is more specific for non-toilet trained infants; however, this did not change the impact of stool characteristics on CoMiSS. 9 Despite being a clinically useful tool in identifying infants with CMA, CoMiSS cannot be used as a cornerstone for diagnosis of infants with obvious CMA such as those with anaphylactic or immediate IgE-mediated reactions who will not be picked up by the CoMiSS, but it may be used as a helpful tool to identify infants with persisting GI symptoms who may benefit from cow milk-free diet (CMFD) when the diagnosis of CMA is suspected. 10 , 11 …”

Section: Introductionmentioning

confidence: 99%

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Evaluation of Cow’s Milk Related Symptom Score [CoMiSS] accuracy in cow’s milk allergy diagnosis

et al. 2023

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Background Cow’s Milk-related Symptom Score (CoMiSS) is an awareness tool to recognize cow’s milk allergy (CMA) symptoms in infants. We aimed to assess the best cut-off point of CoMiSS in our country and investigate other parameters suggested to raise the strength of CoMiSS in CMA diagnosis. Methods We enrolled 100 infants with CMA-suggestive symptoms with documentation of CoMiSS initially and 4 weeks after cow milk-free diet (CMFD) followed by an open food challenge (OFC) test. Infants with symptom recurrence upon challenge were diagnosed with confirmed CMA. Results Initial mean CoMiSS was 15.76 ± 5.29, being higher in the confirmed CMA group (84% of infants). Following CMFD, median CoMiSS significantly reduced to 1.5 in the confirmed CMA group compared to 6.5 in the negative group. Receiver operation characteristic (ROC) curve identified a CoMiSS score of ≥12 as the best cut-off value with 76.19% sensitivity, 62.50% specificity and overall accuracy of 74.00%. Mucoid stool, bloody stool and faltering growth were reported in 80, 41 and 52% of confirmed CMA infants, respectively, with considerable improvement following CMFD. Conclusions Our study revealed a CoMiSS score of ≥12 to be the best cut-off point. However, CoMiSS cannot be used alone for accurate diagnosis of CMA. Impact CoMiSS ≥12 can predict a positive response to CMFD; nevertheless, CoMiSS is a good awareness tool and cannot be regarded as a stand-alone CMA diagnostic test. CoMiSS reduction following CMFD was predictive of a reaction to OFC to diagnose CMA as well as for monitoring symptom improvement. Symptoms commonly associated with CMA as mucoid stool, bloody stool, marked abdominal distention not responding to medical treatment and faltering growth, in addition to their improvements in response to CMA are suggested parameters to be added to CoMiSS to improve its accuracy.

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“…Recently, the previously proposed cut-off point which indicates the likelihood that symptoms may be cow’s milk related was suggested to be lowered from ≥ 12 to ≥ 10. 9 …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evaluation of Cow’s Milk Related Symptom Score [CoMiSS] accuracy in cow’s milk allergy diagnosis

et al. 2023

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“…According to a recent meta‐analysis, CoMiSS may be a promising symptom score in CMA awareness and a useful tool in monitoring the response to a CM‐free diet (126), although it cannot be regarded as a stand‐alone CMA diagnostic test (127). However, there is a lack of agreement on which cut‐off to use (128). CoMiSS reduction following CM elimination was predictive for a reaction in the OFC to diagnose CMA as well as for monitoring symptom improvement (127).…”

Section: Risk Factorsmentioning

confidence: 99%

An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy

Vandenplas

Broekaert

Domellöf

et al. 2024

J. pediatr. gastroenterol. nutr.

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A previous guideline on cow's milk allergy (CMA) developed by the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) was published in 2012. This position paper provides an update on the diagnosis, treatment, and prevention of CMA with focus on gastrointestinal manifestations. All systematic reviews and meta-analyses regarding prevalence, pathophysiology, symptoms, and diagnosis of CMA published after the previous ESPGHAN document were considered. Medline was searched from inception until May 2022 for topics that were not covered in the previous document. After reaching consensus on the manuscript, statements were formulated and voted on each of them with a score between 1 and 9. A score of ≥6 was arbitrarily considered as agreement. Available evidence on the role of dietary practice in the prevention, diagnosis and management of CMA was updated and recommendations formulated. CMA in exclusively breastfed infants exists, but is uncommon and suffers from over-diagnosis. CMA is also over-diagnosed in formula and mixed fed infants. Changes in stool characteristics, feeding aversion or occasional spots of blood in stool are common and in general should not be considered as diagnostic of CMA, irrespective of preceding consumption of cow's milk. Over-diagnosis of CMA occurs much more frequently than under-diagnosis; both have potentially harmful consequences. Therefore, the necessity of a challenge test after a short diagnostic elimination diet of 2-4 weeks is recommended as the cornerstone of the diagnosis. This position paper contains sections on nutrition, growth, cost and quality of life.

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“…Originally, an arbitrary cutoff of ≥12 was suggested as possibly indicating CMA, warranting an elimination diet followed by cow’s milk protein (CMP) reintroduction ( 2 ). A recent review evaluated the performance of CoMiSS in 25 clinical studies and concluded that lowering the cutoff to ≥10 was justified ( 3 ). Previous studies on CoMiSS also demonstrate that scores ≤5 are unlikely to be found in infants with CMA.…”

mentioning

confidence: 99%

Cow’s Milk-Related Symptom Score (CoMiSS): From Bristol to Brussels Stool Scale

Bajerova,

Salvatore,

Dupont

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: The Cow’s Milk-related Symptom Score (CoMISS TM) is an awareness tool for evaluating cow's milk-related symptoms in otherwise healthy infants <1 year of age. This study assessed whether replacing the Bristol Stool Form Scale (BSFS) with the Brussels Infants and Toddlers Stool Scale (BITSS) in non-toilet-trained infants would modify the overall CoMiSS and change the clinical approach regarding potential cow's milk allergy. Methods: Non-toilet-trained infants aged <13 months were assessed by CoMiSS using the seven images from the BSFS (CoMiSS-BSFS) compared to the four images of stools from BITSS (CoMiSS-BITSS). The Wilcoxon Signed-Rank test and Pearson Correlation Coefficient were calculated. A post hoc analysis using identical tests was performed in subsets of CoMiSS-BSFS scores ≥10, ≥12, ≤5 and ≥6. Results: 844 pairwise scores were collected. Applying the Wilcoxon test over the complete dataset, the difference between CoMiSS-BSFS and CoMiSS-BITSS was statistically significant (p<0.001). However, there was no significant difference in the subsets with CoMiSS-BSFS ≥10, ≥12 and ≥6 (p=0.84, p=0.48 and p=0.81, respectively). The significant difference remained restricted to the group with CoMiSS-BSFS ≤5, considered at low risk for CM-related symptoms (p<0.001). Conclusion: Replacing BSFS with BITSS does not change the cut-off for awareness of possible CM-related symptoms and will not impact the use of CoMiSS in clinical practice. Changes in CoMiSS remained limited to the subgroup with a low risk for CM-related symptoms.

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The Cow’s Milk Related Symptom Score: The 2022 Update

Cited by 18 publications

References 51 publications

Evaluation of Cow’s Milk Related Symptom Score [CoMiSS] accuracy in cow’s milk allergy diagnosis

Evaluation of Cow’s Milk Related Symptom Score [CoMiSS] accuracy in cow’s milk allergy diagnosis

An ESPGHAN Position Paper on the Diagnosis, Management, and Prevention of Cow's Milk Allergy

Cow’s Milk-Related Symptom Score (CoMiSS): From Bristol to Brussels Stool Scale

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