The CoMiSS®, published in 2015 in Acta Paediatrica1, increases the awareness of the most common symptoms of CMPA that in turn can aid an earlier accurate diagnosis. It also helps to minimize over- and under- diagnosis of cow's milk-related symptoms as well as evaluate and quantify the evolution of symptoms during a therapeutic intervention. It is important to note that CoMiSS® is NOT a diagnostic test for cow's milk protein allergy (CMPA), and it does not replace a food challenge; its usefullness will need to be evaluated in a prospective randomized study.
The CoMiSS® is intended for primary healthcare providers who are all too often very limited in time and thus need a tool that is simple, fast and easy-to-use.
Functional gastrointestinal symptoms such as regurgitation and vomiting, constipation, crying and colic are considered non-IgE mediated reactions. Atopic eczema is often not recognized as a possible consequence of ingestion of cow's milk protein.
Download the CoMiSS® user guide
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CoMiSS® quantifies the number and severity of symptoms.
Suspicion of 'cow’s milk-related symptoms' based on the presence of a combination of the following symptoms:
Frequent regurgitation, vomiting, diarrhea, constipation (with/without perianal rash), blood in stool.
Runny nose, (otitis media), chronic cough, wheezing (unrelated to infection).
Atopic dermatitis, angioedema, urticaria unrelated to acute infections, drug intake manifestations.
Persistent distress or colic (≥ 3 hours per day wailing/irritable) at least 3 days/week over a period of > 3 weeks.
There are two groups of patients:
- those with obvious CMPA
- those with unclear symptoms in different organ systems
The first group is easy to recognize:
- consists mainly of infants with immediate/ rapid reactions
- most of the time IgE mediated
However, this group represents a minority of all the infants with suspected cow’s milk-related symptoms seen by primary healthcare providers.
In many cases, parents report some or all of these symptoms:
- Infant crying, having 'colic'
- Difficult defecation or 2-3 loose stools per day
- Regurgitates 4 to 6 times a day
- Mild patches of atopic dermatitis
Due to the lack of diagnostic test for CMPA (other than the challenge test), an awareness tool to recognize cow’s milk-related symptoms for use by healthcare providers may increase the awareness and the recognition of symptoms possibly related to cow’s milk, leading to an accurate diagnosis at an earlier stage.
Up to 60% of affected infants have digestive symptoms.
Up to 30% of affected infants have respiratory symptoms.
Up to 70% of affected infants have skin-related symptoms.
Inconsolable crying is very common in infants with CMPA, while anaphylaxis is very rare.
- Vandenplas Y, Dupont C, Eigenmann P, Host A, Kuitunen M, Ribes-Koninckx C, Shah N, Shamir R, Staiano A, Szajewska H, Von Berg A. A workshop report on the development of the Cow’s Milk-related Symptom Score awareness tool for young children. Acta Paediatrica. 2015; 104: 334-9.
- Lifschitz C, Szajewska H. Cow’s milk allergy: evidence-based diagnosis and management for the practitioner. Eur J Pediatr. 2015;174:141-50.
- Høst A. Cow’s milk protein allergy and intolerance in infancy. Some clinical, epidemiological and immunological aspects. Pediatr Allergy Immunol 1994; 5(5 Suppl): 1-36
- Vandenplas Y, Koletzko S, Isolauri E, Hill D, Oranje A, Brueton M, Staiano A Dupont C. Guidelines for the diagnosis and management of cow’s milk protein allergy in infants. Arch Dis Child. 2007;92:902-8.