The Cow's Milk-Related Symptom Score (CoMiSS^TM) in Presumed Healthy Egyptian Infants

The Cow's Milk-Related Symptom Score (CoMiSS) was created as an awareness tool for cow's milk-related symptoms. After different trials, a score of ≥10 was selected to raise awareness. The CoMiSS in healthy infants needs to be determined because the score does not return to 0 during a diagnostic elimination diet. This study aims to establish normal values in healthy Egyptian infants.

In this prospective cross-sectional study, pediatricians determined the CoMiSS in healthy infants ≤ 12 months. Infants seeking medical help due to cow's milk allergy (CMA) symptoms and infants with any known or suspected diseases, preterm delivery, medication, or food supplements were excluded.

A total of 808 infants were included with a median (Q1; Q3) age of 7 (3;10) months (50.7% boys). The median (Q1; Q3) CoMiSS was 5 (5;6). The 95th percentile was 7. There was no significant difference in the median CoMiSS according to gender (p = 0.621) or due to breastfeeding exclusively (p = 0.603). A significant difference was seen in the CoMiSS according to age, although all the age categories had a median CoMiSS of 5.

This study revealed the median CoMiSS is 5 in presumed healthy Egyptian infants aged 0-12 months. The CoMiSS was not dependent on feeding. The determination of the CoMiSS in healthy infants allows for the determination of a cut-off under which CMA is unlikely, and a cut-off to raise awareness of CMA, thereby preventing under- and overdiagnosis. Since the median CoMiSS was not different in European infants, the outcome suggests that the CoMiSS may be a reliable awareness tool for CMA independent of ethnicity. However, additional studies are needed to confirm the previous hypothesis.