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Cow’s Milk-related Symptom Score for cow’s milk allergy assessment: a meta-analysis for test accuracy

Pediatric Research volume 93, pages 772–779 (2023)Cite this article

Abstract

Background

We aimed to assess the ability of Cow’s Milk-related Symptom Score (CoMiss) in screening cow’s milk protein allergy (CMPA) and assess validation of its sensitivity and specificity.

Methods

We searched the PubMed, WOS, Embase, and Ovid databases using broad terms and keywords for the concepts of the symptom-based score (CoMiss) and cow’s milk allergy. We performed the meta-analyses using a meta-package of R software and Meta-DiSc software.

Results

Fourteen studies were included with a total of 1238 children. At cut-off value 12, CoMiss had a pooled sensitivity of 0.64 and a pooled specificity of 0.75. The PLR and NLR were 3.05 and 0.5, respectively. The AUC value of the sROC curve was 0.7866.

CoMiss showed a significant difference in CMPA patients at baseline and after milk elimination for 2–4 weeks (MD, 7.18), as well as between the CMPA-positive group compared with the CMPA-negative group, however, the statistical significancy was obtained after leave study of Selbuz et al. out of the analysis (MD, 4.61).

Conclusions

CoMiss may be a promising symptom score in the Awareness of the symptoms related to cow’s milk allergy and a useful tool in monitoring the response to a cow’s milk-free diet.

Impact

  • Cow’s milk protein allergy (CMPA) is the most frequent food allergy in children under the age of 3 years. Cow’s Milk-related Symptom Score (CoMiss) is a clinical scoring system to assist primary healthcare providers in early detection of CMPA

  • We performed a meta-analysis of CoMiss test accuracy.

  • Our findings reflect that CoMiss may be a promising symptom score in CMPA awareness and a useful tool in monitoring the response to a cow’s milk-free diet.

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Fig. 1
Fig. 2
Fig. 3
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Fig. 5: The Forest plot of CoMiss summarizing.
Fig. 6: Leave-one-out analysis.

Data availability

The data that support the findings of this study are available from the corresponding author [KS], upon reasonable request.

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Acknowledgements

I would like to express my appreciation to Dr. Noha Yahia Ebaid, MD of radio-diagnosis Lecturer at Zagazig University for his support.

Funding

No funding was secured for our study.

Author information

Author notes

  1. These authors contributed equally: Khaled Saad, Anas Elgenidy.

Authors and Affiliations

  1. Pediatric Department, Faculty of Medicine, Assiut University, Assiut, Egypt

    Khaled Saad, Emad M. Hammad, Faisal-Alkhateeb Ahmed, Amir Aboelgheet, Ahmad M. Ali & Samaher F. Taha

  2. Faculty of Medicine, Cairo University, Cairo, Egypt

    Anas Elgenidy, Mostafa Atef, Mostafa K. Abdelsattar & Mahmoud Al-Ashwah

  3. Department of Pediatrics, College of Medicine, Jouf University, Sakaka, Kingdom of Saudi Arabia

    Mohamed Shawky Elfarargy

  4. Department of Pediatrics, Faculty of Medicine, Tanta University, Tanta, Egypt

    Mohamed Shawky Elfarargy

  5. Medical Microbiology and Immunology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt

    Amira H. El-Ashry

  6. Research and Scientific Studies Unit, College of Nursing, Jazan University, Jazan, Saudi Arabia

    Hamad Ghaleb Dailah

  7. Department of Community Health Nursing, Faculty of Nursing, Assiut University, Assiut, Egypt

    Amira Elhoufey

  8. Department of Community Health Nursing, Alddrab University College, Jazan University, Jazan, Saudi Arabia

    Amira Elhoufey

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Contributions

K.S., A.E., M.A.A., A.H.E., and E.E. designed the study and analyzed the data. M.A., A.M.A., F.A.A., S.F.T., M.G.A., and A.E. drafted the manuscript. All authors were involved in the critical analysis of the final version of the manuscript. All authors approved the manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Khaled Saad.

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The authors declare no competing interests.

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All protocols of our study followed the regulations of the research ethics committee of Assiut University.

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Saad, K., Elgenidy, A., Atef, M. et al. Cow’s Milk-related Symptom Score for cow’s milk allergy assessment: a meta-analysis for test accuracy. Pediatr Res 93, 772–779 (2023). https://doi.org/10.1038/s41390-022-02334-y

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