P COMISS SCORE X CMPA X CUTOFF 10 MIGHT BE MORE SENSITIVE

THE CoMiSS AWARENESS TOOL IN CLINICAL PRACTICE

PURPOSE

The CoMiSS is a simple, fast and easy-to-use awareness tool for cow’s milk-related symptoms. It increases awareness of the most common symptoms of cow’s milk protein allergy (CMPA) that in turn can aid an earlier diagnosis. CoMiSS can also be used to evaluate and quantify the evolution of symptoms during a therapeutic intervention.

THE CoMiSS SCORING

The CoMiSS 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 CMPA. 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 extensivley hydrolysed formula.

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THE CoMiSS SCORING FORM

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

DOWNLOAD

SYMPTOMSSCORE

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Crying*?

• ≤1 hour/day0
• 1 to 1.5 hours/day1
• 1.5 to 2 hours/day2
• 2 to 3 hours/day3
• 3 to 4 hours/day4
• 4 to 5 hours/day5
• ≥5 hours/day6

Result 

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Regurgitation?

• 0 to 2 episodes/day0
• ≥3 to ≤5 of small volume1
• >5 episodes of >1 coffee spoon2
• >5 episodes of ± half of the feed in
  <half of the feedings3
• Continuous regurgitations of small volumes
  >30min after each feeding4
• Regurgitation of half to complete volume of
  a feeding in at last half of the feedings5
• Regurgitation of the "complete feeding" after
  each feeding6

Result 

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Stools (Bristol scale)?

• Type 1 and 2 (hard stools)4
• Type 3 and 4 (normal stools)0
• Type 5 (soft stool)2
• Type 6 (liquid stool, if unrelated to infection)4
• Type 7 (watery stools)6

Result 

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Skin Symptoms?

Atopic eczemaHead, neck and trunk

• Absent0
• Mild1
• Moderate2
• Severe3

Result 

 Arms, hands, legs and feet

• Absent0
• Mild1
• Moderate2
• Severe3

Result 

Urticaria

• Yes6
• No0

Result 

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Respiratory symptoms?

• No respiratory symptoms0
• Slight symptoms1
• Mild symptoms2
• Severe symptoms3

Result