Department of Pediatrics, University Hospital Brno, Masaryk's University, 62500 Brno, Czech Republic.
Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Masaryk's University, 62500 Brno, Czech Republic.
Nutrients. 2022 May 14;14(10):2059. doi: 10.3390/nu14102059.
The Cow’s Milk-related Symptom Score (CoMiSS™) was developed as a clinical tool aimed at increasing the awareness of health care professionals for the presence and intensity of clinical manifestations possibly related to cow’s milk (CM) intake. This review summarizes current evidence on CoMiSS. We found twenty-five original studies, one pooled analysis of three studies, and two reviews on CoMiSS. Infants exhibiting symptoms possibly related to CM, present with a higher median CoMiSS (6 to 13; 16 studies) than apparently healthy infants (median from 3 to 4; and mean 3.6−4.7; 5 studies). In children with cow’s milk allergy (CMA), 11 studies found that a CoMiSS of ≥12 predicted a favorable response to a CM-free diet; however, sensitivity (20% to 77%) and specificity (54% to 92%) varied. The decrease of CoMiSS during a CM elimination diet was also predictive of a reaction to an oral food challenge to diagnose CMA. A low CoMiSS (<6) was predictive for the absence of CMA. It was shown that no special training is required to use the tool in a reliable way. Intra-rater reliability was high with very low variability (intra-class correlation 0.93; 95% confidence interval 0.90−0.96; p < 0.001) in repeated assessments. This review found that CoMiSS cannot be considered as a stand-alone CMA diagnostic tool, but that it is a useful awareness tool for CMA as well as for monitoring symptom improvement.
牛乳相关症状评分（CoMiSS）是作为一种临床工具开发的，旨在提高医护人员对与牛乳摄入相关的临床症状的出现和严重程度的认识。本文综述了 CoMiSS 的现有证据。我们发现了 25 项原始研究、1 项 3 项研究的汇总分析以及 2 项关于 CoMiSS 的综述。表现出可能与牛乳相关症状的婴儿，其 CoMiSS 中位数（6-13；16 项研究）高于表现出明显健康的婴儿（中位数为 3-4；均值 3.6-4.7；5 项研究）。在牛乳过敏（CMA）儿童中，11 项研究发现 CoMiSS 评分≥12 预测对无牛乳饮食的良好反应；然而，灵敏度（20%-77%）和特异性（54%-92%）各不相同。在牛乳排除饮食期间 CoMiSS 的降低也可预测对口服食物挑战以诊断 CMA 的反应。CoMiSS 评分低（<6）可预测不存在 CMA。结果表明，无需特殊培训即可可靠使用该工具。在重复评估中，内部评估者的可靠性很高，变异非常低（组内相关系数 0.93；95%置信区间 0.90-0.96；p<0.001）。本综述发现，CoMiSS 不能被视为 CMA 的独立诊断工具，但它是 CMA 以及监测症状改善的有用意识工具。
