Prasad Rajniti, Venkata Ravi Shankar Ayathu, Ghokale Praveen, Chakravarty Pavitra, Anwar Fahmina
Department of Paediatrics, Institute of Medical Science, Banaras Hindu University, Varanasi 221005, India.
Children's Clinic, Dhanwanthri, Mylapore, Chennai 600004, India.
Asia Pac Allergy. 2018 Oct 17;8(4):e36. doi: 10.5415/apallergy.2018.8.e36. eCollection 2018 Oct.
Cow's milk protein causes an unfavorable and unwanted reaction in some individuals called cow's milk protein allergy (CMPA). It is more often imprecise and easily missed in primary care settings. Cow's Milk-related Symptom Score (CoMiSS) was developed as a screening and awareness tool to suggest the presence of CMPA using general, dermatological, gastrointestinal, and respiratory symptoms.
Assess the utility of CoMiSS in the diagnosis of CMPA in Indian children aged between 0 and 24 months.
A pilot multicentric, observational, longitudinal study was conducted over a period of 4 months among infants aged 0-24 months with symptoms suggestive of CMPA to measure the positive and negative predictive value of CoMiSS. A predesigned questionnaire was used to record the information via CoMiSS. The patients were confirmed of having CMPA via oral food challenge/skin prick test or ImmunoCAP test.
A total of 83 children were enrolled in the study and majority of them had gastrointestinal complaints (61%, 51 of 83) followed by respiratory (41%, 34 of 83) and skin complaints (33%, 27 of 83). CoMiSS was >12 in 72.3% of the infants and amongst them 84.3% were confirmed via oral food challenge/ImmunoCAP test. The positive and negative predictive values for CoMiSS were 93% and 33% respectively.
CoMiSS can help predict CMPA in children aged less than 2 years in the Indian primary care setting, aiding in early diagnosis. Prospective randomized studies are needed to evaluate the use of CoMiSS further.
牛奶蛋白会在一些个体中引发不良且不期望出现的反应，即牛奶蛋白过敏（CMPA）。在基层医疗环境中，这种情况往往诊断不准确且容易被漏诊。牛奶相关症状评分（CoMiSS）作为一种筛查和提高认知的工具而开发，用于通过一般症状、皮肤症状、胃肠道症状和呼吸道症状来提示CMPA的存在。
评估CoMiSS在诊断0至24个月印度儿童CMPA中的效用。
开展了一项为期4个月的多中心、观察性纵向试点研究，研究对象为0至24个月有CMPA症状提示的婴儿，以测量CoMiSS的阳性和阴性预测值。通过预先设计的问卷，利用CoMiSS记录信息。通过口服食物激发试验/皮肤点刺试验或免疫化学发光法（ImmunoCAP）检测来确诊患者是否患有CMPA。
共有83名儿童参与研究，其中大多数有胃肠道症状（61%，83例中的51例），其次是呼吸道症状（41%，83例中的34例）和皮肤症状（33%，83例中的27例）。72.3%的婴儿CoMiSS评分>12，其中84.3%通过口服食物激发试验/免疫化学发光法检测确诊。CoMiSS的阳性和阴性预测值分别为93%和33%。
在印度基层医疗环境中，CoMiSS有助于预测2岁以下儿童的CMPA，有助于早期诊断。需要进行前瞻性随机研究以进一步评估CoMiSS的应用。
