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KMID : 1038820170200010022
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Pediatric Gastroenterology, Hepatology & Nutrition
2017 Volume.20 No. 1 p.22 ~ p.26
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Pooled Analysis of the Cow’s Milk-related-Symptom-Score (CoMiSSTM) as a Predictor for Cow’s Milk Related Symptoms
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Vandenplas Yvan
Steenhout Philippe
Jarvi Anette
Garreau Anne-Sophie
Mukherjee Rajat
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Abstract
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Purpose: The diagnosis of cow’s milk (CM) allergy is a challenge. The Cow’s Milk-related-Symptom-Score (CoMiSSTM) was developed to offer primary health care providers a reliable diagnostic tool for CM related symptoms. The predictive prospective value of the CoMiSSTM 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 CoMiSSTM, adjusting for baseline CoMiSSTM 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 CoMiSSTM from baseline as a predictor.
Results: Results suggest that infants having a low CoMiSSTM (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 CoMiSSTM 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 CoMiSSTM has the potential to be of interest in infants suspected to have CM-related-symptoms. A prospective validation trial is needed.
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KEYWORD
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Cow’s milk protein allergy, Cow’s milk-related-symptom-score extensive hydrolysate
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