الفهرس 
Introduction
food allergyOnly 14 pages are availabe for public view
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Abstract
This study is a cross sectional study that aimed to detect cow’s milk protein allergy by using COMISS score in pediatric patientswith persistent or recurrent GI manifestations. The study included 152 pediatric patients. Their ages varied between 1.5 months to 12 months during a period of 1stJanuary 2020 to 31st December 2020(one year study). Persistent or recurrent GI manifestations are more common among males’ infants, rural residence, infants with illiterate parents and infants who were less than 6 months. Persistent or recurrent diarrhea is the most commonly presented GI manifestations followed by vomiting and regurgitation, then colic and constipation. 17% of studied cases have respiratory complaints in the form of recurrent wheezes and (9.2%) have dermatological manifestations mainly eczema. Caesarean section (CS) was more common than normal vaginal delivery, full-term reported higher incidence of persistent or recurrent GI manifestations than pre-term infants. Breastfeeding is protective against the development of persistent and recurrent GI manifestation than artificial feeding. The introduction of complementary feeding before 6 months increases the incidence of persistent and recurrent GI manifestation. Bilateral wheezy chest was presented in16.5% of the studied cases, 2.6% suffered from crepitation. Pan-systolic murmur and hepatomegaly observed in 1.8% and 1.3% respectively. Persistent or recurrent illness markedly associated with delay in mental and physical development due to severe malnutrition. 27% suffered from delayed both mental and physical development, while 28.3% suffered from only physical delay.Thrombocytopenia presented in 2.6% mainly due to sepsis and 27.6% presented with anemia. Regarding the anthropometric measures of our studied infants, all parameters of presence of acute and chronic malnutrition was significantly higher in infants with persistent or recurrent GI manifestations. The mean CoMiSS score in the present study was 9.7 and the presenting symptoms in our studied infants were as the following, diarrhea was the most common finding, followed by regurgitation, crying, respiratory manifistation, and skin finding. The mean CoMiSS score was not different according to sex, meanwhile it was higher in infant < 6 months, at the addition of feeding (artificial or breast or complementary) and decrease up to 1 year, infants with positive consanguinity, and infants with positive family history of allergic diseases. Regarding the GI manifestations, there were statistically significant difference between CoMiSS Score groups (<12 and ≥12) and the presence of (in descending order) recurrent diarrhea, recurrent vomiting, regurge (persistent and recurrent), recurrent colic and persistent vomiting. This significant increase of CoMiSS Score with recurrent GI symptoms is concomitant with CoMiSS score structure itself. Artificially feed infants have higher CoMiSS ≥12, meanwhile breastfeeding infants have lower CoMiSS <12. Infants who began complementary food after 6 months have higher CoMiSS Score.Modes of delivery, duration of pregnancy and admission to NICU have no influence on mean CoMiSS Score. The CMPA have no influence on the neurological development of the studied cases and CBC parameters (WBCs, HB, platelets). Infants with CoMiSS Score ≥12 significantly suffered from underweight, wasting, and microcephaly, which suggest that failure to thrive or malnutrition may occur as a consequence of cow’s milk allergy. On summation; CoMiSS Score is a simple, fast, and easy-to-use useful tool for screening infants who presented with recurrent or persistent GI manifestations.