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Europe: Researchers develop tool to detect cow’s milk protein allergy in infants

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A panel of experts has developed the Cow’s Milk-related Symptom Score Tool (CoMiSS) that is available through Nestlé Health Science.

The tool is a scoring system based form designed to help primary healthcare professionals earlier recognize and assess non-specific symptoms – originating from various organ systems – that may be related to cow’s milk protein allergy (CMPA) in infants.

This condition occurs in an estimated 2-3% of infants.

Existing data shows that the predictive value of the tool in identifying infants at risk of CMPA can be 80%.

Difficulty assessing these symptoms has meant CPMA is frequently under, over or mis-diagnosed, or diagnosis is considerably delayed until a food challenge is eventually organized and undertaken by paediatric specialists.

Tool features

The use of CoMiSS at primary healthcare level should increase awareness of recognition of CPMA symptoms to help accelerate decision-making and correct management of a condition that can lead to poor growth and development if not addressed.

CoMiSS may also be used to evaluate and quantify the evolution of symptoms during a therapeutic intervention.

It takes the tool five to 15 minutes for the practitioner – usually a doctor – to complete in conjunction with a parent (bringing their infant) based upon discussion of past and present symptoms.

Scores are assigned to crying, regurgitation, stool, skin and respiratory symptoms.

Total scores ranges form 0-33.

A score of 12 or above picks up the criterion for infants at risk of CPMA.

Ease and speed of use are key advantages as Professor Vandenplas, chair of the 11 strong Expert Consensus Panel – all of whom are clinicians with expertise in infant gastrointestinal (GI) problems and/or atopic diseases – explains: “Busy primary healthcare professionals are not expected to be expert in such complex conditions.”

He is also chair of Paediatrics at the Free University of Brussels Academic Hospital, Belgium.

“This tool addresses that reality with a fact-based scoring system encompassing key measures. Easy and rapid to use, we believe CoMiSS is a pro-active step forward in reducing the delays and difficulties often seen in the management of CMPA.”

“These can be distressing for the infant, parents and not least healthcare professionals,” he says.

There is no diagnostic test for CMPA.

Although functional GI symptoms such as regurgitation and vomiting, constipation, crying and colic are considered to be related to the ingestion of cow’s milk, atopic eczema is often not recognised as a possible consequence of ingestion of cow’s milk protein.

CoMiSS is not designed to identify anaphylactic or immediate immunoglobulin E-mediated reactions or to provide a diagnosis of CMPA.

The diagnosis can only be confirmed by an elimination diet followed by an oral food challenge.

The CoMiSS will be evaluated in prospective randomized studies to assess its efficacy in identifying cow’s milk related symptoms that respond to elimination from the diet.