Tracking Tiny Tummies: How CoMiSS Helps Monitor Milk Allergy Diets
Hey there! Let’s dive into a topic that touches many new parents: figuring out what’s bothering their little one’s tummy. Cow’s milk protein allergy (CMPA) is super common in babies, especially in that first year. It can show up in different ways, and one type is called CMP-associated allergic proctocolitis, or CMPAP for short. Basically, it means the cow’s milk protein is causing some inflammation in the baby’s lower gut, often showing up as bloody or mucousy stools.
Diagnosing CMPA, especially the non-IgE mediated kind like CMPAP, isn’t always straightforward. There isn’t a single blood test that gives a clear “yes” or “no.” Usually, doctors rely on symptoms and seeing if those symptoms disappear when cow’s milk is removed from the diet (for mom if breastfeeding, or the baby’s formula) and reappear if it’s brought back.
This is where tools to help track symptoms come in handy. One such tool is the Cow’s Milk Protein Related Symptom Score, or CoMiSS. It was developed as a screening tool to help identify babies who *might* have CMPA. But what if it could do more? What if it could actually help us see how well a special diet is working? That’s exactly what a recent study set out to explore.
Putting CoMiSS to the Test for Monitoring
So, the big question was: Can CoMiSS be used not just to *suspect* CMPA, but to *monitor* how babies with CMPAP respond to an elimination diet? Up until now, there hasn’t been much research looking at CoMiSS for this specific purpose, especially in a defined group like CMPAP infants.
This study, conducted by some dedicated researchers, compared infants diagnosed with CMPAP who were on an elimination diet to a group of healthy infants. They looked at babies between 17 and 26 weeks old at the start and followed them over several months, checking in at six, seven, nine, and twelve months of age. At each visit, they assessed the babies using the CoMiSS score.
The infants with CMPAP had been diagnosed based on a clear pattern: bloody stools that went away quickly when cow’s milk was removed from their diet (or their breastfeeding mother’s diet) and came back when it was reintroduced. The CMPAP babies and their moms followed an elimination diet, guided by a dietitian, and gradually started reintroducing milk products using something called the “milk ladder” as the babies got older. The healthy babies just ate age-appropriate food without any dietary restrictions.
What Does CoMiSS Measure Anyway?
Before we look at the results, let’s quickly recap what the CoMiSS score actually tracks. It’s a simple way to score different symptoms that can be related to cow’s milk protein issues. It looks at:
- Stool pattern (like consistency)
- Crying (how much and how intense)
- Regurgitation (spitting up)
- Skin symptoms (like rashes)
- Respiratory symptoms (like wheezing)
Each symptom gets a score, and they’re added up for a total score ranging from 0 to 33. A higher score generally means more symptoms.
The Results Are In!
Okay, so what did they find? At the very beginning of the study, as you’d expect, the babies with CMPAP had significantly higher total CoMiSS scores than the healthy babies. Their median score was 10, while the healthy babies’ median was 4. This makes sense – the CMPAP babies were experiencing symptoms!
But here’s the exciting part: After just four weeks on the elimination diet (that was Visit 1), the total CoMiSS scores in the CMPAP group dropped significantly compared to their starting scores. This is a big deal because it suggests the diet was working and the CoMiSS score was reflecting that improvement! While their scores were still higher than the healthy babies at Visit 1, the *decrease* from baseline was clear.
Interestingly, by Visit 2 (around 9 months), there wasn’t a significant difference in total scores between the groups. However, things changed again by Visit 3 (around 12 months). At this point, as the babies were starting to reintroduce milk via the milk ladder, the total CoMiSS scores increased in *both* groups compared to the previous visit, but they were significantly higher in the CMPAP group again compared to the healthy controls.
Digging Deeper: Specific Symptoms
While the total score is helpful, looking at individual symptoms tells us more. The researchers found that the *crying score* was significantly higher in the CMPAP infants compared to healthy controls at the start, at Visit 1 (after the initial diet), and again at Visit 3 (when milk was being reintroduced). Even when the babies seemed better based on other symptoms, the crying often persisted or increased upon re-exposure.
This persistence of crying, even when bloody stools had resolved on the diet, is fascinating. The researchers wondered if it might be an indirect sign of ongoing inflammation in the gut, even if it wasn’t visible in the stool. Or perhaps crying in these babies is linked to other factors like gut motility issues or changes in gut bacteria (dysbiosis), which are also being explored as causes of colic.
What about the symptom that defines CMPAP – the bloody, mucousy stools? Surprisingly, the *defecation score* in CoMiSS didn’t show a significant difference between the CMPAP babies and the healthy controls throughout the study. The researchers think this is a limitation of the current CoMiSS score. It primarily evaluates stool *consistency* (hard, soft, etc.) but doesn’t specifically score the *frequency* of bowel movements or, crucially for CMPAP, the *presence of blood or mucus*. This suggests the CoMiSS defecation score might need some tweaking to be more useful for monitoring CMPAP specifically.
Other symptoms like regurgitation and respiratory issues weren’t significantly different between the groups, which makes sense as CMPAP mainly affects the gut. Skin scores *were* higher in the CMPAP group at the start, but this was likely because many of those babies also had atopic dermatitis, which is common alongside CMPA.
So, Can CoMiSS Really Help?
Based on these findings, it seems CoMiSS *can* be a promising tool for monitoring how well an elimination diet is working for infants with CMPAP, especially in the early stages. The significant drop in total scores after starting the diet is a positive sign that the score reflects clinical improvement. The study even noted that the decrease in CoMiSS scores in the CMPAP group during the elimination diet was more than 50%, which aligns with suggestions from the CoMiSS developers for identifying diet response.
However, the study also highlights that CoMiSS isn’t perfect for CMPAP *yet*. While it captured the overall improvement and the persistent crying, the defecation score needs refinement to better reflect the key symptom of bloody stools.
What does this mean for parents and doctors? It suggests that tracking symptoms using a tool like CoMiSS, particularly paying attention to the crying score and potentially a modified defecation score, could help guide management. It could help determine if the diet is working, if adjustments are needed, or if the baby is developing tolerance to milk as they get older and milk is reintroduced.
Looking Ahead
This study is a great first step in showing that CoMiSS has potential beyond just screening. It suggests it can be a valuable tool for monitoring treatment response in a specific, common type of infant food allergy.
Of course, like any study, this one had its challenges, including the pandemic affecting recruitment and follow-up. The timing of the first CoMiSS assessment after the diet started might also have influenced the defecation scores.
The increase in scores seen at the end of the study, particularly the crying score as milk was reintroduced, points to the dynamic nature of CMPA and the importance of continued monitoring. It also raises questions about how best to assess tolerance development.
The big takeaway for me is that while CoMiSS is a useful starting point, we need more research. Future studies should look at using a refined CoMiSS (with a better defecation score for CMPAP) and follow babies for longer to see how reliable it is for long-term management and guiding decisions about reintroducing milk.
Ultimately, anything that helps us better understand and manage these tricky infant allergies is a win for both babies and their families! This study paves the way for making CoMiSS an even more powerful tool in our kit.
Source: Springer
