We believe breast milk is the best food for infants. When in consultation with their healthcare professional, mothers and families find that optimal breastfeeding is not possible due to their infant’s medical condition, formulas for special medical purposes play a vital role in providing essential nutrients to infants. We have a global commitment to market breast-milk substitutes responsibly.
CoMiSS® awareness tool
Leading experts have developed the Cow’s Milk-related Symptom Score (CoMiSS®)1, which is a fast and easy-to-use tool to help healthcare professionals recognize and assess non-specific signs and symptoms that could be indicative of CMPA as early as possible.
Find out more about CoMiSS®
CoMiSS® tutorial video
Watch the CoMiSS® tutorial video
CoMiSS® awareness tool
Your steps on the diagnosis path
The overall goal is to shorten the diagnosis process and reduce the patient burden. Achieving this goal involves multiple steps: checking the infant’s symptoms and family history; performing diagnostic tests; and confirming the diagnosis with an elimination diet followed by food challenge.
The first step is to check for signs and symptoms that could be related to CMPA. It is also important to collect the family history for atopic diseases, as the risk for allergies is higher in families with existing allergic disease.Signs & symptoms CoMiSS® tool
Available diagnostic methods
Few procedures exist to detect different types of CMPA; however, none of these tests, except for the elimination diet followed by food challenge, can provide a conclusive diagnosis. The elimination diet followed by food challenge is recommended by guidelines as the gold standard diagnostic test.2,3
Elimination diet and food challenge
The elimination diet consists of the elimination of cow’s milk protein (CMP) from the infant’s diet (which means eliminating CMP from the mother’s diet in case of breast feeding).
If elimination of the CMP from the infant’s diet does not improve symptoms, CMPA is highly unlikely. If symptoms improve, an oral food challenge is usually performed by controlled re-introduction of CMP to confirm the diagnosis of CMPA.4,5
When CMPA has been confirmed, a therapeutic elimination diet free from CMP will be required.
Guidelines for diagnosis and management
More detailed information about the diagnosis and management of CMPA can be found in the European Society of Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) and in the European Academy of Allergy and Clinical Immunology (EAACI) guidelines.2,4Read the ESPGHAN Guidelines
Read the EAACI Guidelines
Expert corner: CMPA diagnosis
Watch leading experts sharing their experience in diagnosing CMPA, including investigating the likelihood of CMPA with the CoMiSS® tool, the available allergy tests, and confirming the diagnosis with an elimination diet followed by oral food challenge.
- Vandenplas Y, et al. A workshop report on the development of the Cow’s Milk-related Symptom Score awareness tool for young children. Acta Paediatr. 2015;104(4):334–9.
- Koletzko S, et al. Diagnostic approach and management of cow’s-milk protein allergy in infants and children: ESPGHAN GI Committee practical guidelines. J Pediatr Gastroenterol Nutr. 2012;55(2):221–9.
- Luyt D, et al. BSACI guideline for the diagnosis and management of cow’s milk allergy. Clin Exp Allergy. 2014;44(5):642–72.
- Muraro A, et al. EAACI Food Allergy and Anaphylaxis Guidelines: diagnosis and management of food allergy. Allergy. 2014;69:1008–25.
- Vandenplas Y, et al. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child. 2007;92:902–8.