الفهرس 
C OW S M ILK A LLERGYOnly 14 pages are availabe for public view
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Abstract
Background: The prevalence of cow’s milk protein allergy (CMA) in the first year of life varies from 1.4 to 3.8%. The Cow’s Milk-related Symptom Score (CoMiSS) was published in 2014 and is considered an awareness tool for cow’s milk protein allergy. Many patients who are not suspected for CMA (with scores below 12) are shown later to have CMA.
Aim of the Work: To assess the validity and reliability of the current cutoff value of COMiSS score and to find out whether another cutoff value is more appropriate.
Patients and Methods: This randomized prospective cohort study was carried out on 100 infants below one year with symptoms and signs suggestive of cow’s milk allergy. Full history taking and full clinical assessment was applied to all patients (phase I). Classification of patients based on CpMiSS into two groups; group A with a score of 12 or more and group B with a score below 12 (Phase II). Re-evaluation of patients and final diagnosis of every individual in our study was made 3 months after enrollment (Phase III).
Results: The included patients presented with different gastrointestinal, nutritional and respiratory findings (underweight in 69.6%, Respirtory symptoms in 57.1%, bloody stool in 51.1%, diarrhea in 48.2% and constipation in 32.1%). CoMiSS score of 12 or more failed to pick up 44.6% (25 patients of 56) of ultimate diagnosis of CMA. On the other hand a score of 10 or more was capable to diagnose 19.6 % (11 patients of 56) of patients with ultimate diagnosis of CMA with a sensitivity of 80.36% and specificity of 77.27%.
Conclusion: We conclude that the proposed cutoff value of ≥ 12 for COMiSS score is under estimating the condition. We propose a cutoff value of ≥ 10 which was the most predictive for CMA in addition to formula feeding, complementary feeding including early dairy products and maternal urinary tract infection during pregnancy.