الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
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Abstract
Primary health care physicians are insufficiently aware of symptoms caused by cow milk because there is no pathognomonic symptom and no reliable diagnostic test, which results in repeated consultations and inaccurate management.
Due to the lack of other reliable diagnostic tests other than a food challenge with cow milk protein, infants suspected of suffering from cow’s milk protein allergy (CMPA), developing an awareness tool to recognize cow’s milk related symptoms in infants and young children for use by primary healthcare providers may help, as its name implies, in increasing the awareness and the recognition of cow’s milk related symptoms. Such a tool, helping in decision-making and correct management, would be appreciated by the parents because it will avoid both over and under-diagnosis, and also shorten the duration of distress of the infants and parental anxiety.
Delayed diagnosis of CMPA has a negative impact on the physical development of children.
A Cow’s Milk-related-Symptom-Score (CoMiSS), a score that considers general manifestations, dermatological, gastrointestinal and respiratory symptoms, was developed to be used as an awareness tool for cow’s milk related symptoms. The CoMiSS can also be used to evaluate and quantify the evolution of symptoms during a therapeutic intervention.
However, the CoMiSS does not diagnose CMPA and does not replace a food challenge. Its usefulness needs still to be evaluated by a prospective randomized study.
The non-specific signs and symptoms of CMPA, ranging from colic and reflux to constipation, insomnia, eczema, diarrhea and crying, make diagnosis a real challenge. The symptoms involve many different organ systems, predominantly the skin and the gastrointestinal and respiratory tracts. The involvement of two or more organ systems increases the likelihood of CMPA.
The gastrointestinal symptoms are more common and severe in children, so fecal inflammatory biomarkers of CMPA have been taken into consideration. One of the candidates is calprotectin, a calcium- and zinc-binding protein expressed in neutrophils, monocytes, macrophages and even in mucosal epithelial cells.
It is a protein biomarker of inflammation and can be detected in body fluid and stool.