Cow’s Milk-related Symptom Score (CoMiSS™)

Cow’s Milk Related Symptom Score (CoMiSS™) is an awareness tool for healthcare professionals. You can use it to evaluate the full range of symptoms typically related to cow's milk.

Mother holding and kissing her baby boy Mother holding and kissing her baby boy

Cow’s Milk-related
Symptom Score

Cow’s Milk Related Symptom Score (CoMiSS™) is an awareness tool for healthcare professionals. You can use it to evaluate the full range of symptoms typically related to cow's milk.

What is CoMiSS™?

First developed by a group of leading international experts in 2014, CoMiSS™ is a simple, fast and easy-to-use tool for infants 12 months.

The intention of CoMiSS is to:

  • Increase awareness of the most common symptoms seen in infants with CMPA, helping to speed up the diagnostic process.
  • Support HCPs to quantify and evaluate symptoms in infants with suspected CMPA.
  • Please note CoMiSS™ is not a diagnostic tool.

Please note that CoMiSS™ is not intended for use in infants with severe, life-threatening symptoms clearly indicating CMPA, including anaphylaxis, which requires an urgent referral to an HCP.

CMPA's diagnostic path.

CoMiSS™ Tool

Start scoring now with the interactive version of the CoMiSS™.

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SmilesBack mobile application to track CMPA symptoms.

CoMiSS™ User Guide

Download the user guide that explains clearly each scoring section of CoMiSS™

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CoMiSS™ presented at ESPGHAN

Explained by CoMiSS™ experts

The CoMiSS™ user guide

Explained by expert Dr Kateřina Bajerová

Why is CMPA 
Sometimes Difficult 
to Diagnose?

Cow's Milk Protein Allergy (CMPA) is an adverse immune reaction to cow's milk and affects up to 3% of infants globally making it one of the most common food allergies in early life.1,2

Early identification of CMPA can be life-changing for infants and families, but diagnosis can be challenging for Healthcare Professionals (HCPs).




Challenge Diagnosing CMPA 1: Symptoms overlap with common conditions. Symptoms can overlap with other common infant health conditions, such as colic and regurgitation2

Consequence of delayed CMPA diagnosis 1: Increased costs; higher healthcare usage. Increase costs and higher healthcare usage4,5

Diagnosing CMPA 2: Hard to diagnose; lack of tests. Non-IgE-mediated CMA cases are often harder to diagnose and supportive tests are not available2,3

Consequence of delayed CMPA diagnosis 2: Inappropriate dietary changes. Inappropriate dietary changes4

Challenge Diagnosing CMPA 3: Multiple doctor visits before an official diagnosis. It can take several visits to the doctor and months before an official diagnosis is made

Consequence of delayed CMPA diagnosis 3: Impact on infants' growth and development. Impact on infants growth and development6

Challenge Diagnosing CMPA 4: Primary care HCPs unfamiliar with Cow's Milk Allergy symptoms and guidelines. Many primary care HCPs are not always very familiar with the common symptoms of CMA and the CMA guidelines for diagnosis and management3

Consequence of delayed CMPA diagnosis 4: Lower quality of life. Lower quality of life6,7

Supported by
Clinical Studies

Since 2015 there have been over 30 clinical studies conducted and published using CoMiSS™. Based on this new clinical evidence and their years of experience, the group of international experts updated CoMiSS™ and it was launched at the ESPGHAN congress in 2022.

CMPA's diagnostic path.

Supported by 30
clinical studies and

What were the key updates to CoMiSS™?2

  • The overall cut off score indicating the presence of CMPA has been reduced from ≥ 12 to ≥ 10.
  • The Bristol Stool Scale has been replaced by the Brussels Infant and Toddlers Stool Scale (BITSS), to better reflect the stool consistency of non-toilet trained infants.
  • Clearer guidance has been provided for healthcare professionals to indicate for which infants the tool is not appropriate, and situations that may require immediate referral (such as anaphylaxis, failure to thrive, and sick infants with hematochezia [blood in stool]).

CoMiSS™ at ESPGHAN 2022

Chairs Introduction

Meet the experts discussing CoMiSS™ at ESPGHAN.

Why Is the Diagnosis of CMPA So Challenging

Learn about how CMPA can be mis-diagnosed and how this can impact the young infant.

CoMiSS™ Lessons Learnt

Evidence presented from at least 25 clinical studies that have used CoMiSS™.

CoMiSS™: the 2022 Updates

Hear the latest updates to CoMiSS™ based on extensive evidence

Questions and Answers

Hear the audience Q&A that followed the discussion.

Nestlé owns the copyright to CoMiSS™ and that each of the 3 versions on the website falls under this copyright