The Cow’s Milk Related Symptom Score (CoMiSS®) was first developed by a group of internationally well-known experts in 2015¹ as an awareness tool for healthcare professionals to evaluate the presence of symptoms in infants related to cow’s milk.

  • CoMiSS® is a simple, fast, and easy-to-use awareness tool for cow’s milk-related symptoms, intended to be used by healthcare professionals.
  • CoMiSS® increases awareness of the most common symptoms of CMA that can aid an earlier diagnosis.
  • CoMiSS® can also be used to evaluate and quantify the evolution of symptoms during a therapeutic intervention.
  • CoMiSS® is intended to be used in children under 1 year.
  • The tool is not intended for infants with severe and life-threatening symptoms clearly indicating CMA, including anaphylaxis, which requires urgent referral.

The CoMiSS® scoring form is not intended to be used as a diagnostic tool and should not replace an oral food challenge (OFC).
Diagnosis of CMA can only be confirmed by a 2-to-4-week elimination diet followed by an OFC.

Group of experts have revised and updated CoMiSS® ?

Since 2015 there have been 25 clinical studies2 conducted and published using CoMiSS®. Based on this new clinical evidence and years of experience the group of international experts updated CoMiSS® in 2022 and launched at ESPGHAN 2022.


  1. The overall cut off score has been reduced to ≥10 (from ≥12) which is suggestive of CMA.
  2. The Bristol Stool Scale has been replaced by the Brussels Infant and Toddlers Stool Scale which better reflects the stool consistency of non-toilet trained infants.
  3. Clearer guidance is provided for healthcare professionals to indicate those infants for whom the tool is not intended and those infants that require immediate referral e.g. with anaphylaxis, failure to thrive and sick infants with hematochezia.

Learn more about the NEW updated CoMiSS® and watch the satellite symposia from ESPGHAN 2022 here(will be available from the 4th July)


  1. Vandenplas Y, Dupont C, Eigenmann P, et al. A workshop report on the development of the Cow’s Milk related Symptom Score awareness tool for young children. Acta Paediatr. 2015 Apr;104(4):334-9
  2. Bajerova, K, Salvatore S, Dupont C et al. The Cow’s Milk-Related Symptom Score (CoMiSS™): A Useful Awareness Tool. Nutrients 2022, 14, 2059.
  3. Vandenplas et al. Cow’s Milk related Symptom Score: the update. Submitted. 2022.
IMPORTANT NOTICE: Mothers should be encouraged to continue breastfeeding even when their babies have cow’s milk protein allergy. This usually requires qualified dietary counselling to completely exclude all sources of cow’s 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.