Sistema de puntuación CoMiSS de síntomas asociados a la leche de vaca: ¿cuándo puede ser útil para los pediatras españoles?

Abstract

The Cow's Milk-related Symptom Score (CoMiSS) is a practical tool to assess for cow's milk protein allergy (CMPA) in infants based on clinical manifestations, although the diagnosis of CMPA should be confirmed subsequently by a specialist in pediatrics and/or pediatric gastroenterology and nutrition. The aim of this study was to compare CoMiSS results in infants diagnosed with IgE-mediated and non-IgE-mediated CMPA. Material and methods Multicenter, cross-sectional survey study with participation of pediatricians throughout Spain. Pediatricians were directed to apply the CoMiSS to infants at the time of diagnosis of CMPA and 7days after initiating nutritional management with an extensively hydrolyzed formula (EHF). We interpreted a CoMiSS score of 12 or greater as positive. Results A total of 294 pediatricians (mean age, 51years) participated in the study. The analysis included CoMiSS results for 1176 infants with CMPA (mean [SD] age: 6.4 [4.9] months), of who 66.8% (n=745) had non-IgE-mediated CMPA. We found a greater decrease in the mean score in the IgE-mediated group compared to the non-IgE-mediated group (mean [SD] −9.06 [5.74] vs −6.00 [4.05]; P<.0001). When it came to individual symptoms, there were significantly greater reductions in the mean scores for crying and regurgitation in the non-IgE-mediated group, and, conversely, significantly greater reductions in the scores for atopic eczema in the head and arms, urticaria and respiratory symptoms in the IgE-mediated group. There was also a greater decrease in the total CoMiSS score in infants with very severe CMPA compared to infants with severe, moderate and mild CMPA. Conclusion This survey showed that only one third of infants diagnosed with CMPA had a positive CoMiSS result of 12points or greater at the time of diagnosis, which suggests an inadequate use of the CoMiSS. We recommend the implementation of strategies to increase knowledge of the utility of the CoMiSS for the assessment of CMPA.