Pediatr Gastroenterol Hepatol Nutr.  2017 Mar;20(1):22-26. 10.5223/pghn.2017.20.1.22.

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

• Vandenplas Y
• Steenhout
• Järvi A
• Garreau AS
• Mukherjee

• KMID: 2375274
• DOI: http://doi.org/10.5223/pghn.2017.20.1.22

Abstract

PURPOSE
The diagnosis of cow's milk (CM) allergy is a challenge. The Cow's Milk-related-Symptom-Score (CoMiSSâ„¢) was developed to offer primary health care providers a reliable diagnostic tool for CM related symptoms. The predictive prospective value of the CoMiSSâ„¢ 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 CoMiSSâ„¢, adjusting for baseline CoMiSSâ„¢ 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 CoMiSSâ„¢ from baseline as a predictor.
RESULTS
Results suggest that infants having a low CoMiSSâ„¢ (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 CoMiSSâ„¢ 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 CoMiSSâ„¢ has the potential to be of interest in infants suspected to have CM-related-symptoms. A prospective validation trial is needed.

Keyword

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

MeSH Terms

Diagnosis
Humans
Hypersensitivity
Infant
Logistic Models
Milk*
Primary Health Care
Prospective Studies
Statistics as Topic

Figure

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  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.

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