Vandenplas Yvan, Steenhout Philippe, Järvi Anette, Garreau Anne-Sophie, Mukherjee Rajat
Department of Pediatrics, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
Nestlé Health Science, Vevey, Switzerland.
Pediatr Gastroenterol Hepatol Nutr. 2017 Mar;20(1):22-26. doi: 10.5223/pghn.2017.20.1.22. Epub 2017 Mar 27.
The diagnosis of cow's milk (CM) allergy is a challenge. The Cow's Milk-related-Symptom-Score (CoMiSS™) was developed to offer primary health care providers a reliable diagnostic tool for CM related symptoms. The predictive prospective value of the CoMiSS™ was evaluated in three clinical trials.
Pooled analyses of the three studies were conducted based on regressing the results of the month-1 challenge test on the month-1 CoMiSS™, adjusting for baseline CoMiSS™ 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 CoMiSS™ from baseline as a predictor.
Results suggest that infants having a low CoMiSS™ (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; =0.002). Pooled data suggest that the change in CoMiSS™ 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.
Pooled data analysis emphasizes that the CoMiSS™ has the potential to be of interest in infants suspected to have CM-related-symptoms. A prospective validation trial is needed.
牛奶（CM）过敏的诊断颇具挑战。开发了牛奶相关症状评分（CoMiSS™），为初级医疗保健提供者提供一种用于诊断与CM相关症状的可靠工具。在三项临床试验中评估了CoMiSS™的预测前瞻性价值。
基于将第1个月激发试验结果对第1个月的CoMiSS™进行回归分析，并使用逻辑回归模型对基线CoMiSS™进行调整，对三项研究进行汇总分析。此外，还将逻辑回归模型应用于第1个月激发试验结果，将CoMiSS™相对于基线的变化作为预测指标。
结果表明，在接受不含完整CM蛋白的饮食治疗1个月后CoMiSS™较低（中位数为5）的婴儿，激发试验呈阳性的风险显著（优势比为0.83；95%置信区间为0.75 - 0.93；P = 0.002）。汇总数据表明，CoMiSS™从基线到第1个月的变化可预测与CM相关的症状，这是根据第1个月的激发试验确诊的。然而，为了验证这样一种工具，还需要将无CM相关症状的婴儿纳入验证试验。一个担忧是，让健康婴儿接触治疗性配方奶粉和进行激发试验可能不符合伦理。
汇总数据分析强调，CoMiSS™对于疑似有CM相关症状的婴儿可能具有潜在意义。需要进行前瞻性验证试验。
