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first_pagesettingsOrder Article Reprints Open AccessReview The Cow’s Milk-Related Symptom Score (CoMiSS™): A Useful Awareness Tool by Katerina Bajerova 1,2,†,Silvia Salvatore 3,†,Christophe Dupont 4ORCID,Philippe Eigenmann 5,Mikael Kuitunen 6,Rosan Meyer 7,8,9,Carmen Ribes-Koninckx 10,Raanan Shamir 11ORCID,Hania Szajewska 12 andYvan Vandenplas 13,*ORCID 1 Department of Pediatrics, University Hospital Brno, Masaryk’s University, 62500 Brno, Czech Republic 2 Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Masaryk’s University, 62500 Brno, Czech Republic 3 Department of Paediatrics, University of Insubria, 21100 Varese, Italy 4 Ramsay Group, France et Clinique Marcel Sembat, Paris Descartes University, 92100 Boulogne-Billancourt, France 5 Pediatric Allergy Unit, Department of Pediatrics, University Hospitals of Geneva, 1205 Geneva, Switzerland 6 Children’s Hospital, Helsinki University Hospital, University of Helsinki, 00029 Helsinki, Finland 7 Department Paediatrics, Imperial College London, London SW3 6LY, UK 8 Department Dietetics, Winchester University, Winchester SO23 4NR, UK 9 Department Medicine, KU Leuven, 3000 Leuven, Belgium 10 Pediatric Gastroenterology, La Fe University Hospital, 46026 Valencia, Spain add Show full affiliation list * Author to whom correspondence should be addressed. † These authors contributed equally to this work. Nutrients 2022, 14(10), 2059; https://doi.org/10.3390/nu14102059 Received: 9 April 2022 / Revised: 28 April 2022 / Accepted: 11 May 2022 / Published: 14 May 2022 (This article belongs to the Section Pediatric Nutrition) Download Browse Figure Review Reports Versions Notes Abstract The Cow’s Milk-related Symptom Score (CoMiSS™) was developed as a clinical tool aimed at increasing the awareness of health care professionals for the presence and intensity of clinical manifestations possibly related to cow’s milk (CM) intake. This review summarizes current evidence on CoMiSS. We found twenty-five original studies, one pooled analysis of three studies, and two reviews on CoMiSS. Infants exhibiting symptoms possibly related to CM, present with a higher median CoMiSS (6 to 13; 16 studies) than apparently healthy infants (median from 3 to 4; and mean 3.6–4.7; 5 studies). In children with cow’s milk allergy (CMA), 11 studies found that a CoMiSS of ?12 predicted a favorable response to a CM-free diet; however, sensitivity (20% to 77%) and specificity (54% to 92%) varied. The decrease of CoMiSS during a CM elimination diet was also predictive of a reaction to an oral food challenge to diagnose CMA. A low CoMiSS (<6) was predictive for the absence of CMA. It was shown that no special training is required to use the tool in a reliable way. Intra-rater reliability was high with very low variability (intra-class correlation 0.93; 95% confidence interval 0.90–0.96; p < 0.001) in repeated assessments. This review found that CoMiSS cannot be considered as a stand-alone CMA diagnostic tool, but that it is a useful awareness tool for CMA as well as for monitoring symptom improvement.
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