The purpose of this study was to evaluate the diagnosis and management of infants presenting with symptoms attributable to cow’s milk allergy (CMA) in a real life setting and to test how the Cow’s Milk-related Symptom Score (CoMiSS^®) can be used to support the awareness to diagnose cow’s milk protein allergy in primary care practice. The CoMiSS is an awareness tool based on various symptoms such as crying, gastrointestinal symptoms, dermatological and respiratory symptoms. The study was conducted on 268 infants from four countries (Belgium, Czech Republic, Germany, UK) aged 0 to 18 months consulting for CMA related symptoms. The analysis was based on two visits of these subjects. The results show an average CoMiSS of 11 at the first visit. After a therapeutic dietary intervention, the score at the second visit, which happened 3 weeks ± 5 days after the first one, dropped to an average value of 4. A satisfaction questionnaire completed by the primary care practitioners suggested an overall high level of satisfaction with the application of the CoMiSS tool in routine practice. These data highlight a huge discrepancy in the diagnosis and management of infants suspected of CMA in the different countries. The findings suggest that the CoMISS questionnaire is an effective tool in aiding awareness of CMPA in primary health care.

Indrio F, et al. Pediatr Gastroenterol Hepatol Nutr. 2021 Jul;24(4):325-336. https://doi.org/10.5223/pghn.2021.24.4.325

Universal admission screening for SARS-CoV-2 in children and their caregivers (CG) is critical to prevent hospital outbreaks. We evaluated pooled SARS-CoV-2 antigen tests (AG) to identify infectious individuals while waiting for polymerase chain reaction (PCR) test results. This single-center study was performed from November 5, 2020 to March 1, 2021. Nasal mid-turbinate and oropharyngeal swabbing for AG and PCR testing was performed in children with 2 individual swabs that were simultaneously inserted. Nasopharyngeal swabs were obtained from their CG. AG swabs were pooled in a single extraction buffer tube and PCR swabs in a single viral medium. Results from an adult population were used for comparison, as no pooled testing was performed. During the study period, 710 asymptomatic children and their CG were admitted. Pooled AG sensitivity and specificity was 75% and 99.4% respectively for detection of infectious individuals. Four false negatives were observed, though 3 out of 4 false negative child-CG pairs were not considered infectious at admission. Unpooled AG testing in an adult population showed a comparable sensitivity and specificity of 50% and 99.7%. AG performed significantly better in samples with lower Ct values in the corresponding PCR (32.3 vs 21, P-value < .001). Pooled SARS-CoV-2 AGs are an effective method to identify potentially contagious individuals prior admission, without adding additional strain to the child.

Background/Objectives: International guidelines recommend a short-term milk-free elimination diet and oral food challenge (OFC), with or without specific IgE testing, for diagnosing cow’s milk allergy (CMA), with extensively hydrolysed formulas (eHF) or amino acid formulas (AAF) as first-line nutritional therapy. In some countries, par-tially hydrolysed whey formula (pHF-W) is used as a step-down, or bridge, to intact cow’s milk protein (CMP), despite limited supporting evidence. This study explored real-world diagnostic practices and experiences with pHF-W step-down use among healthcare professionals (HCPs) in China and the Middle East. Methods: An online cross-sectional survey was conducted among 600 HCPs including paediatricians, gas-troenterologists, allergists/immunologists, and dermatologists, from China, Bahrain, Kuwait, Saudi Arabia, and United Arab Emirates. IPSOS translated the 25-item ques-tionnaire into local languages, were responsible for HCP selection and implementation. Results: While 71% of respondents used a food elimination diet, OFCs were only used by 46%. The majority relied on history/physical examination (91%) and/or specific IgE testing (85%), raising concerns about misdiagnosis. While most respondents reported using eHF or AAF for first-line nutritional management, 20% used pHF-W, diverging from guideline recommendations. Seventy-seven percent of HCPs employed pHF-W as a step-down formula before intact CMP, citing improved tolerance and reduced re-currence. Over 80% of HCPs using pHF-W in this way expressed satisfaction, with 53% recommending it for 3–6 months. Conclusions: CMA diagnostic and management practices in China and the Middle East show variable adherence to international guidelines. Frequent pHF-W use highlights the need for educational interventions, better guideline dissemination, and further research to evaluate its safety and efficacy in step-down approach for CMA management.