The Cow’s Milk-Related Symptom Score (CoMiSS™): A Useful Awareness Tool
, Philippe Eigenmann 5, Mikael Kuitunen 6, Rosan Meyer 7,8,9, Carmen Ribes-Koninckx 10, Raanan Shamir 11, Hania Szajewska 12 and Yvan Vandenplas 13,*
Ray Mullins
Round 1
Reviewer 1 Report
Summary
The authors summarise the use of a scoring system designed to assist in the diagnosis of non-IgE mediated symptoms secondary to cows milk exposure in infants aged up to 6 months. The symptoms used are somewhat non-specific in that are they generally those common in early life – crying, irritability, regurgitation, eczema, stool characteristics or respiratory symptoms. A score of at least 12 was associated with a high positive predictive value of improvement upon cows milk withdrawal; and relapse upon challenge. Of 28 papers examined, 14 were by the authors of this review. Gender and feeding method (breast or formula) were not shown to influence the scores. There was reasonable agreement on scores estimated by parents and health professionals. The authors propose the use of the score as a relatively easy tool to use in the evaluation of infants with suspected cows milk reactivity, although the cutoff for a significant score is as yet unclear.
Comment
I have not been aware of the use of such a scoring system previously, which may be employed more commonly in Europe than in Australasia. While I can see the potential convenience of use of such as score, I would be more likely to consider specific diagnoses such as FPIES or proctocolitis or eosinophilic esophagitis or lactose intolerance or eczema aggravated by non IgE mediate dairy allergy. Furthermore, in considering reactions to cows milk., soy co-reactivity is common in proctocolitis and FPIES so such children are unlikely to respond to a cows milk only elimination strategy. I think the authors could at least mention specific diagnoses in their discussion including these caveats related to soy
Author Response
Dear reviewer
We thank you for your comments and constructive suggestions. We added them to the revised version (line 447-451): It may be of interest to consider the future development of tools for more specific diagnoses such as FPIES, allergic proctocolitis, eosinophilic esophagitis, lactose intolerance or eczema aggravated by non IgE mediate dairy allergy. Furthermore, soy co-reactivity in combination with CM is common in proctocolitis and FPIES, and should be considered in upcoming versions of an awareness tool
Reviewer 2 Report
Comment and Suggestion for Authors
The article aims to clarify the role of the CoMiSS in the diagnosis and management of children with suspected cow's milk allergy by analyzing the scientific evidence in this regard. Given the heterogeneity of the studies on this topic, the goal is difficult. However, the authors managed to analyze the various studies with scientific accuracy and made a classification of the same according to various criteria. The paper is enriched with numerous tables, however, they are not very clear at a first reading and require a commitment from the reader to be well interpreted. I suggest to improve the tables in order to make them more easily interpretable by the read.
line 93 were 28 publications considered out of how many?
line 58 delayed: it would be useful to specify the time
line 76 was the cited article published in 2014 or 2015?
Tab 2 the legend of abbreviations is missing
Tab 3 add columns giving information on gender and nationality that are only described in the text
Table 5 it would be helpful to include a column with the number of subjects. Also, not 17/11 but 17 vs 11 etc, retrospective and prospective (R and P) and add it in the legend
Tab 6 add column with number of subjects in the various studies.
Author Response
Dear reviewer
We thank you for your comments and constructive suggestions.
All comments are included in the revised version
Line 93 were 28 publications considered out of how many?
There were only 28 papers in total
line 58 delayed: it would be useful to specify the time
We replaced the (2 to 4 weeks after ingestion) and put it after delayed - we hope this is more clear now
line 76 was the cited article published in 2014 or 2015?
We thank the reviewer to have noticed this typo. It was corrected. (It was 2015 - pubmed; but if you log in through Acta it says 2014)
Tab 2 the legend of abbreviations is missing
We thank the reviewer to have noticed this; a legend was added.
Tab 3 add columns giving information on gender and nationality that are only described in the text
Done
