The Cow’s Milk Related Symptom Score: The 2022 Update

Vandenplas, Yvan; Bajerova, Katerina; Dupont, Christophe; Eigenmann, Philippe; Kuitunen, Mikael; Meyer, Rosan; Ribes-Koninckx, Carmen; Salvatore, Silvia; Shamir, Raanan; Szajewska, Hania

doi:10.3390/nu14132682

Open AccessConcept Paper

The Cow’s Milk Related Symptom Score: The 2022 Update

by

Yvan Vandenplas

^1,*

,

Katerina Bajerova

^2,3,

Christophe Dupont

⁴

,

Philippe Eigenmann

⁵,

Mikael Kuitunen

⁶,

Rosan Meyer

^7,8,9,

Carmen Ribes-Koninckx

¹⁰,

Silvia Salvatore

¹¹,

Raanan Shamir

¹²

and

Hania Szajewska

¹³

¹

Vrije Universiteit Brussel (VUB), UZ Brussel, KidZ Health Castle, Laarbeeklaan 101, 1090 Brussels, Belgium

²

Department of Pediatrics, University Hospital Brno and Masaryk’s University, 625 00 Brno, Czech Republic

³

Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno and Masaryk´s University, 625 00 Brno, Czech Republic

⁴

Ramsay Group, France et Clinique Marcel Sembat, Paris Descartes University, Boulogne-Billancourt, 75004 Paris, France

⁵

Pediatric Allergy Unit, University Hospitals of Geneva, 1205 Geneva, Switzerland

⁶

Children’s Hospital, University of Helsinki and Helsinki University Hospital, 00290 Helsinki, Finland

⁷

Department Paediatrics, Imperial College London, London SW7 2BX, UK

⁸

Department Dietetics, Winchester University, Winchester SO23 4NR, UK

⁹

Department Medicine, KU Leuven, 3001 Leuven, Belgium

¹⁰

Pediatric Gastroenterology, La Fe University Hospital, Instituto de Iinvestigacion Sanitaria La FE Valencia, 46026 Valencia, Spain

¹¹

Department of Paediatrics, University of Insubria, 21100 Varese, Italy

¹²

Institute of Gastroenterology, Nutrition and Liver Diseases, Schneider Children’s Medical Center, Lea and Arieh Pickel for Pediatric Research, Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv 69978, Israel

¹³

Department of Paediatrics, The Medical University of Warsaw, 02-014 Warsaw, Poland

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^*

Author to whom correspondence should be addressed.

Nutrients 2022, 14(13), 2682; https://doi.org/10.3390/nu14132682

Submission received: 29 May 2022 / Revised: 22 June 2022 / Accepted: 25 June 2022 / Published: 28 June 2022

(This article belongs to the Special Issue Advances in Nutrition in Pediatric Gastroenterology)

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Abstract

CoMiSS^® was developed 7 years ago to increase the awareness of health care professionals towards the possibility that symptoms presented by infants could be related to cow’s milk. While CoMiSS was conceived mostly on theoretical concepts, data is now available from 25 clinical trials. Based on this extensive research using the tool since 2015, we aim to propose an updated CoMiSS. The evidence was reviewed, debated and discussed by 10 experts, of whom seven were part of the original group. The panel concluded that the cut-off previously proposed to indicate the likelihood that symptoms may be cow’s milk related should be lowered from ≥12 to ≥10. Data in healthy infants > 6 months are missing. Since the Brussels Infant and Toddlers Stool Scale (BITSS) was recently developed for non-toilet trained children, the Bristol Stool Scale was changed to the BITSS without changing the impact of stool characteristics on CoMiSS. Overall, CoMiSS raises awareness that symptoms might be cow’s milk related. New studies are needed to determine if the change in cut-off and other small adaptions improve its sensitivity and specificity. Data for CoMiSS is still needed in presumed healthy infants between 6 and 12 months old. There may also be regional differences in CoMiSS, in healthy infants as well as in those with cow’s milk allergy. Finally, we emphasize that CoMiSS is an awareness tool and not a diagnostic test.

Keywords: cow’s milk allergy; cow’s milk-related symptom score; CoMiSS; functional gastrointestinal disorder; infant feeding

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MDPI and ACS Style

Vandenplas, Y.; Bajerova, K.; Dupont, C.; Eigenmann, P.; Kuitunen, M.; Meyer, R.; Ribes-Koninckx, C.; Salvatore, S.; Shamir, R.; Szajewska, H. The Cow’s Milk Related Symptom Score: The 2022 Update. Nutrients 2022, 14, 2682. https://doi.org/10.3390/nu14132682

AMA Style

Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R, Ribes-Koninckx C, Salvatore S, Shamir R, Szajewska H. The Cow’s Milk Related Symptom Score: The 2022 Update. Nutrients. 2022; 14(13):2682. https://doi.org/10.3390/nu14132682

Chicago/Turabian Style

Vandenplas, Yvan, Katerina Bajerova, Christophe Dupont, Philippe Eigenmann, Mikael Kuitunen, Rosan Meyer, Carmen Ribes-Koninckx, Silvia Salvatore, Raanan Shamir, and Hania Szajewska. 2022. "The Cow’s Milk Related Symptom Score: The 2022 Update" Nutrients 14, no. 13: 2682. https://doi.org/10.3390/nu14132682

APA Style

Vandenplas, Y., Bajerova, K., Dupont, C., Eigenmann, P., Kuitunen, M., Meyer, R., Ribes-Koninckx, C., Salvatore, S., Shamir, R., & Szajewska, H. (2022). The Cow’s Milk Related Symptom Score: The 2022 Update. Nutrients, 14(13), 2682. https://doi.org/10.3390/nu14132682

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