Runny nose is the excess drainage of clear fluid or thick mucus produced by nasal and adjacent tissues and blood vessels in the nose.1 Sneezing is the sudden, forceful, uncontrolled burst of air through the nose and mouth caused by irritation to the mucus membranes of the nose or throat.2

What causes runny nose and sneezing in infants?
Both runny nose and sneezing in newborns and infants may be due to infections, such as the common cold or flu, or allergies, such as hay fever or dust allergies.2 Both are symptoms of rhinitis, which can have allergic or non-allergic aetiologies.3,4

Runny nose and sneezing as symptoms of Cows' Milk Allergy
Rhinitis symptoms (including runny nose and sneezing) can also be due to Cow’s Milk Allergy (CMA). For infants with CMA, rhinitis symptoms will manifest themselves rapidly following the ingestion of cows' milk.5

The majority of infants affected with CMA have at least two symptoms affecting at least two different organ systems.6,7 If you suspect non-IgE mediated CMA8,9,10, you can use the CoMiSS® tool11 to score the combination of their symptoms and assess the likelihood of CMA.

Other signs and symptoms related to CMA8,9,10
  • Gastrointestinal/Digestive: Vomiting, reflux, regurgitation, anorexia, diarrhoea, constipation, abdominal pain, blood in stools
  • Respiratory: Chronic cough, sneezing, wheezing, shortness of breath, runny nose
  • Skin: Rash, atopic dermatitis, urticaria, angioedema
  • General: Failure to thrive, anaphylaxis, insomnia, inconsolable crying, pallor and tiredness
Baby with running nose

How to score this symptom with the CoMiSSTM tool
  • The combination of respiratory symptoms is given a score
  • The higher the score the greater the severity of symptom
  • In addition to the respiratory symptoms, if any of the following signs or symptoms related to CMA are also present, they should also be given a score using the CoMiSSTM tool. These include diarrhoea, constipation, regurgitation and skin (atopic dermatitis and urticaria) symptoms


The Cows' Milk-related Symptom Score (CoMiSSTM) is a simple, fast and easy-to-use awareness tool designed to help you more easily recognise the signs and symptoms that can be cows' milk-related in infants and young children.


If you suspect your patient is suffering from symptoms that may be suggestive of CMA, use the CoMiSSTM tool to score and assess the likelihood of CMA.

Other Symptoms of Cows' Milk Allergy


  1. Mayo Clinic: Runny nose definition. (Accessed March 2016)
  2. Medline Plus: Sneezing (Accessed March 2016)
  3. Mayo Clinic: Non-allergic rhinitis. (Accessed March 2016)
  4. Mayo Clinic: Allergic rhinitis. (Accessed March 2016)
  5. Caffarelli C., et al. It J Pediatr. 2010;36:5
  6. Koletzko S et al J Pediatr Gastroenterol Nutr. 2012;55(2):221–9
  7. Lifschitz C. and Szajewska H. Eur J Pediatr. 2015;174:141
  8. Høst A. Pediatr Allergy Immunol. 1994;5:1–36
  9. Luyt D., et al Clin Exp Allergy, 2014;44:642–672
  10. National Institute of Health Care and Excellence Clinical Knowledge Summarises. Cows’ milk protein allergy in children, 2015!diagnosissub/-617759 (Accessed October 2016)
  11. Vandenplas Y., et al Acta Paed. 2015;104:334–39

IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cows' milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cows' milk protein from the mothers’ diet. If a decision to use a special formula intended for infants is taken, it is important to follow the instructions on the label. Unboiled water, unboiled bottles or incorrect dilution can make babies ill. Incorrect storage, handling, preparation and feeding can eventually lead to adverse effects on the health of babies. Formula for special medical purposes intended for infants must be used under medical supervision.