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The CoMiSS Awareness Tool

The CoMiSS Awareness Tool


The CoMiSSTM is a simple, fast and easy-to-use awareness tool for non-IgE mediated cows' milk-related symptoms. It increases awareness of the most common symptoms of cows' milk allergy (CMA) that in turn can aid an earlier diagnosis. CoMiSSTM can also be used to evaluate and quantify the evolution of symptoms during a therapeutic intervention.


The CoMiSSTM 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 CMA. 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 extensiviley hydrolysed formula.

CoMiSSTM is not a diagnostic tool. CMA diagnosis can only be confirmed by an elimination diet followed by an oral food challenge.


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

Stools (Bristol scale)*
Atopic eczema: Head, neck and trunk*
Atopic eczema: Arms, hands, legs and feet*
Respiratory symptoms*