Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2017 Mar;20(1):22-26.
doi: 10.5223/pghn.2017.20.1.22. Epub 2017 Mar 27.

Pooled Analysis of the Cow's Milk-related-Symptom-Score (CoMiSS™) as a Predictor for Cow's Milk Related Symptoms

Yvan Vandenplas  1 , Philippe Steenhout  2 , Anette Järvi  2 , Anne-Sophie Garreau  3 , Rajat Mukherjee  4
Affiliations

Pooled Analysis of the Cow's Milk-related-Symptom-Score (CoMiSS™) as a Predictor for Cow's Milk Related Symptoms

Yvan Vandenplas et al. Pediatr Gastroenterol Hepatol Nutr. 2017 Mar.

Abstract

Purpose: The diagnosis of cow's milk (CM) allergy is a challenge. The Cow's Milk-related-Symptom-Score (CoMiSS™) was developed to offer primary health care providers a reliable diagnostic tool for CM related symptoms. The predictive prospective value of the CoMiSS™ was evaluated in three clinical trials.

Methods: Pooled analyses of the three studies were conducted based on regressing the results of the month-1 challenge test on the month-1 CoMiSS™, adjusting for baseline CoMiSS™ using a logistic regression model. In addition a logistic regression model was also fitted to the month-1 challenge test result with the change in CoMiSS™ from baseline as a predictor.

Results: Results suggest that infants having a low CoMiSS™ (median, 5) after 1 month dietary treatment free from intact CM protein have a significant risk of having a positive challenge test (odds ratio, 0.83; 95% confidence interval, 0.75-0.93; p=0.002). Pooled data suggest that the change in CoMiSS™ from baseline to month-1 can predict CM related symptoms as a confirmed diagnosis according to the challenge test at month-1. However, in order to validate such a tool, infants without CM related symptoms would also need to be enrolled in a validation trial. A concern is that it may not be ethical to expose healthy infants to a therapeutic formula and a challenge test.

Conclusion: Pooled data analysis emphasizes that the CoMiSS™ has the potential to be of interest in infants suspected to have CM-related-symptoms. A prospective validation trial is needed.

Keywords: Cow's milk protein allergy; Cow's milk-related-symptom-score extensive hydrolysate.

PubMed Disclaimer

Figures

Fig. 1
Fig. 1. The receiver operating characteristics (ROC)-curve predicting probability to have positive challenge test. A typical ROC curve for predicting month-1 challenge test result based on the change in Cow's Milk-related-Symptom-Score (CoMiSS™) from baseline to month-1 and based on data generated to cover the entire range of the CoMiSS™ (0-12). The area under the curve (AUC) of the ROC curve is 0.88. The thin straight line depicts random prediction with an AUC of 0.5.
See this image and copyright information in PMC

References

    1. Robbins KA, Wood RA, Keet CA. Milk allergy is associated with decreased growth in US children. J Allergy Clin Immunol. 2014;134:1466–1468.e6. - PMC - PubMed
    1. Vieira MC, Morais MB, Spolidoro JV, Toporovski MS, Cardoso AL, Araujo GT, et al. A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy. BMC Pediatr. 2010;10:25. - PMC - PubMed
    1. Vandenplas Y, Dupont C, Eigenmann P, Host A, Kuitunen M, Ribes-Koninckx C, et al. A workshop report on the development of the cow's milk-related symptom score awareness tool for young children. Acta Paediatr. 2015;104:334–339. - PubMed
    1. Vandenplas Y, Steenhout P, Planoudis Y, Grathwohl D Althera Study Group. Treating cow's milk protein allergy: a double-blind randomized trial comparing two extensively hydrolysed formulas with probiotics. Acta Paediatr. 2013;102:990–998. - PubMed
    1. Vandenplas Y, De Greef E, Hauser B Paradice Study Group. Safety and tolerance of a new extensively hydrolyzed rice protein-based formula in the management of infants with cow's milk protein allergy. Eur J Pediatr. 2014;173:1209–1216. - PMC - PubMed