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CoMiSS®

Symptom

Crying *

As assessed by parents without any obvious cause ≥1 week duration

Please select the most appropriate response

(0 points)
(1 point)
(2 points)
(3 points)
(4 points)
(5 points)
(6 points)
Points: 0
Symptom

Regurgitation *

As assessed by parents with no obvious cause ≥1 week duration

Please select the most appropriate response

(0 points)
(1 point)
(2 points)
(3 points)
(4 points)
(5 points)
(6 points)
Points: 0
Symptom

Stool *

Brussels Infant and Toddlers Stool Scale (BITSS) score ≥1 week durationo

Please select the most appropriate response

(4 points)
(0 points)
(4 points)
(6 points)
Points: 0
Symptom

Skin

HEAD-NECK-TRUNK Atopic eczema ≥1 week duration

Please select the most appropriate answer

(0 points)
(1 point)
(2 points)
(3 points)

ARMS-HANDS-LEGS-FEET

Atopic eczema ≥1 week duration

Please select the most appropriate answer

(0 points)
(1 point)
(2 points)
(3 points)
Points: 0

(Acute) Hives* and/or angioedema*

Please select the most appropriate answer

(0 points)
(6 points)
Points: 0
Symptom

Respiratory*

≥1 week duration

Please select the most appropriate answer

(0 points)
(1 point)
(2 points)
(3 points)
Points: 0

* In the absence of infectious disease.

TOTAL Points:0

Interpretation of the total score

Total score ≥10: May be suggestive of   cow's milk-related symptoms and could potentially be CMPA.
Total score <6: Symptoms are probably not related to  CMPA. Look for other causes.

The CoMiSS® scoring form is not intended to be used as a diagnostic tool and should not replace an oral food challenge test (OCT).
The diagnosis of CMPA should be confirmed by a 2- to 4-week elimination diet followed by an oral food challenge test.

Additional information to consider


Worsening eczema may be indicative of CMPA. If the urticaria/angioedema is directly related to cow’s milk (e.g., drinking milk in the absence of other foods), this is strongly suggestive of CMPA.
Reference: Vandenplas Y, Bajerova K, Dupont C, Eigenmann P, Kuitunen M, Meyer R, Ribes-Koninckx C, Salvatore S, Shamir R, Szajewska H. The Cow’s Milk Related Symptom Score: The 2022 Update. Nutrients 2022, 14, 2682. https://doi.org/10.3390/nu14132682