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THE CoMiSS AWARENESS TOOL IN CLINICAL PRACTICE

CoMiSS: Cow's Milk-related Symptom Score

PURPOSE

The CoMiSS is a simple, fast and easy-to-use awareness tool for cow’s milk-related symptoms. It increases awareness of the most common symptoms of cow’s milk protein allergy (CMPA) that in turn can aid an earlier diagnosis. CoMiSS can also be used to evaluate and quantify the evolution of symptoms during a therapeutic intervention.

THE CoMiSS SCORING

The CoMiSS score ranges from 0 to 33.

Each symptom has a maximal score of six, with the exception of respiratory symptoms (maximal score of three).

An arbitrary cut-off value of ≥12 was selected as the criterion to pick up infants at risk of CMPA. A score of 12 requires the presence of at least two severe symptoms and a score higher than 12 requires the presence of at least three symptoms and the involvement of two organ systems.

Published data using the CoMiSS in clinical trials show that the predictive value of the tool is 80% if the score is >12 at the start and decreases to < 6 within 2 weeks under an elimination diet with an extensivley hydrolysed formula.


 

THE CoMiSS SCORING FORM

Now rate the observed/reported symptoms by choosing the most appropriate score for each type of symptom or download the blank scoring form.

Download
SYMPTOMSSCORE

 
!Ensure you have answered this section.
Crying*?
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

 
!Ensure you have answered this section.
Regurgitation?
  • 0
  • 1
  • 2
  • 3
  • 4
  • 5
  • 6

 
!Ensure you have answered this section.
Stools (Bristol scale)?
  • 4
  • 0
  • 2
  • 4
  • 6

 
Skin Symptoms?
!Ensure you have answered this section.
Atopic eczemaHead, neck and trunk
  • 0
  • 1
  • 2
  • 3
!Ensure you have answered this section.
 Arms, hands, legs and feet
  • 0
  • 1
  • 2
  • 3
!Ensure you have answered this section.
Urticaria
  • 6
  • 0

 
!Ensure you have answered this section.
Respiratory symptoms?
  • 0
  • 1
  • 2
  • 3

 

* Crying only considered if the child has been crying for 1 week or more, assessed by the parents, without any other obvious cause.

READING THE RESULT

The scoring ranges from 0 to 33. Each symptom has a maximal score of 6, except respiratory symptoms where the maximal score is 3.
If final score ≥ 12, the symptoms are likely cow’s milk related. This could potentially be CMPA.
If final score <12, the symptoms are less likely related to cow’s milk. Look for other causes.

CMPA diagnosis can only be confirmed by an elimination diet followed by an oral food challenge.

Vandenplas, Y., Dupont, C., Eigenmann, P., Host, A., Kuitunen, M., Ribes-Koninck, C., Shah, N., Shamir, R., Staiano, A., Szajewska, H. and Von Berg, A. (2015), A workshop report on the development of the Cow’s Milk-related Symptom Score awareness tool for young children. Acta Paediatrica. doi: 10.1111/apa.12902

© 2015 Nestlé Health Science
CRYING*

- The duration of crying is evaluated. The longer the crying, the higher the score.

- At least > 3 days / week for 1 week or more, assessed by the parents, without any other obvious cause.

- Crying relates to colic. Colic is defined as > 3 hours crying / day for at least 3 days during 1 week and since at least 1 week.

- Up to 3 hours of crying / day accounts for a score of 3.


Age: > 2 weeks, < 4 months


* Should only be considered if the child was crying for 1 week or more, assessed by the parents and without any other obvious cause.

REGURGITATION

- Using the score for grading the regurgitation.1

- Rates the regurgitated volume and severity of the regurgitation.


Age: > 2 weeks, < 6 months


1- Vandenplas Y, Hachimi-Idrissi S, Casteels A, Mahler T, Loeb H. A clinical trial with an “anti-regurgitation” formula. Eur J Pediatr. 1994;153:419-23.

STOOLS

Using the well established Bristol stool scale to evaluate the consistency of the stools.1



For at least one week

1- Lewis SJ, Heaton KW. Stool form scale as a useful guide to intestinal transit time. Scand. J. Gastroenterol.1997; 32: 920–4.

SKIN

An easy way to apply score based on an estimation of the surface covered by the dermatitis, using the surface estimation drawings from burns.

Estimated surface
0 = 0
< 1/3rd = 1
1/3-2/3rd = 2
> 2/3rd = 3

RESPIRATORY

Respiratory symptoms are considered in the CoMiSS although they have been given less importance (lower weighting) because most of the time chronic cough, runny nose and even wheezing are caused by viral infections.

However, respiratory symptoms can be caused by cow’s milk:

- Chronic cough
- Runny nose
- Wheezing

FINAL SCORE
13 / 33

A total score of < 12 indicates the symptoms are less likely to be related to
cow’s milk. Look for other causes.


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> Diagnostic support> Read more about CMPA

A total score of ≥ 12 indicates the symptoms are likely cow's milk-related.

This could potentially be cow's milk protein allergy (CMPA). However, a CMPA
diagnosis can only be confirmed by an elimination diet followed by a oral food
challenge.


Print full test results via your browser or share link with detailed results.

Print


> Diagnostic support> Choose the right solution