CoMiSS™ to Increase CMA Awareness: Lessons Learnt

The Cow’s Milk-related Symptom Score (CoMiSS™) was developed as a clinical tool aimed at increasing the awareness of health care professionals for the presence and intensity of clinical manifestations possibly related to cow’s milk (CM) intake. A review of current evidence on CoMiSS™, including 25 original studies, one pooled analysis of three studies and two reviews on CoMiSS™ revealed that infants exhibiting symptoms possibly related to CM, present with a higher median CoMiSS™ than apparently healthy infants. In children with cow´s milk allergy (CMA), 11 studies found that a CoMiSS™ of ≥12 predicted a favorable response to a CM-free diet; however, sensitivity and specificity varied. The decrease of CoMiSS™ during a CM elimination diet was also predictive of a reaction to an oral food challenge to diagnose CMA. A low CoMiSS™ (<6) was predictive for the absence of CMA. It was shown that no special training is required to use the tool in a reliable way. CoMiSS™ cannot be considered as a stand-alone CMA diagnostic tool, but it is a useful awareness tool for CMA as well as for monitoring symptom improvement during CM dietary elimination.