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How Are Infants Suspected to Have Cow’s Milk Allergy Managed? A Real World Study Report

Published in Nutrients, August 2021

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The diagnosis of cow’s milk allergy (CMA) can be challenging as the symptoms can be immediate or delayed and can involve many organ systems. The Cow’s Milk-related Symptom Score (CoMiSS) is a tool is designed to be used by different healthcare professionals (HCP’s) with varying levels of expertise, in a variety of settings (scores range from 0-39 and assess symptoms including crying, regurgitation, stools, skin symptoms, urticarial and respiratory symptoms). The purpose of this study was to ‘assess in a real-life situation the diagnosis and management of infants presenting with symptoms attributable to CMA and to test the usefulness of the CoMiSS’

This was a multi-centre, prospective, observational study carried out by 84 HCP’s from recruiting sites located in 4 European countries (Belgium, Germany, Czech Republic and the United Kingdom). Infants (aged 0-18 months) suspected of mild-moderate symptoms of CMA were enrolled. The study design included 2 visits, in which demographic, dietary and medical data were recorded and the CoMiSS score was determined. The HCP was asked to complete a satisfaction questionnaire about the use of the CoMiSS tool. 

Recruitment from Sep 2016-Sep 2018, enrolled 268 subjects (145 boys / 117 girls / 6 unknown) with an average age of 21.9 weeks (range 1.4-80.6 weeks). The mean duration of symptoms was 12 weeks and ranged from 7 weeks (Belgium) to 24 weeks (UK). Overall the mean CoMiSS score was 11.1 and 72.3% of subjects had a CoMiSS of >9 and 48.9% a CoMiSS ≥12. The CoMiSS score was lowest in the UK. The data shows large variations in the CoMiSS scores, the elimination diets used and the type of formula used when the 4 countries were compared. The CoMiSS at the final visit (246/268, 94% subjects) was significantly lower suggesting efficacy of the therapeutic action taken (overall mean 4.2). The HCP’s had a high level of satisfaction with the tool. 

The authors conclude that this observational study showed that the CoMiSS tool is an effective tool in aiding the awareness of CMA in real life for HCP’s. What it also highlighted was the discrepancy in the diagnosis and management of infants suspected of having CMA in the 4 different countries using different healthcare systems.