Validity of Cow's Milk-related Symptom Score among Children suspected to have Cow's Milk protein Allergy

Background: Cow's milk allergy is a predictable immune response to certain proteins found in cow's milk. This reaction consistently causes a range of symptoms, such as gastrointestinal, respiratory, and skin issues, after consuming the problematic food. This condition affects approximately 2-5% of infants. Objectives: The aim of the current study was to evaluate the validity of CoMiSS in children suspected to have Cow's Milk Protein Allergy (CMPA). Methods: A prospective observational study was conducted among 100 targeted patients presenting with one or more of the following CMPA symptoms: cutaneous (atopic dermatitis and urticaria), respiratory (cough and dyspnea, rhinitis), and gastrointestinal (digestive regurgitation, vomiting, rectal bleeding, constipation and diarrhea) at Pediatrics department, Sohag university hospitals, Egypt from 1st of December 2022 to 31st August, 2023 ,CoMiSS, 2016 and elimination diet and food challenge test were applied to all cases. Results: comparison between Confirmed CMA (positive challenge test) and non-CMA (negative challenge test) regarding CoMiSS at first visit. There was statistically significant difference between confirmed CMA and non-CMA according to cut off point of CoMiSS either < 12 or ≥ 12 (P-value < 0.001). 9 cases had CoMiSS < 12 and confirmed CMA by food challenge elimination test. On the other hand, 2 of cases had CoMiSS ≥ 12 and confirmed No CMA by food challenge test. 64 cases had CoMiSS ≥ 12 and confirmed CMA by diet elimination and food challenge test and assessment of ROC curve showed that the accuracy of CoMiSS in diagnosis of CMA, it was 89 %. The percentage of Sensitivity was (87.7 %), Specificity (92.6 %), Positive predictive value % (96.9 %) when the score is ≥ 12, Negative predictive value % (73.5 %). Conclusion: The accuracy of CoMiSS in diagnosis of CMA was 89 % with sensitivity (87.7 %), specificity (92.6 %), positive predictive value % (96.9 %) when the score is ≥ 12 & negative predictive value % (73.5 %) so, CoMiSS is an easy-to-use and practical awareness tool for evaluating CM-related symptoms but cannot be considered a stand alone diagnostic tool for CMA.