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.

Children's Hospital Helsinki University Hospital University of Helsinki 00029 Helsinki Finland

Department Dietetics Winchester University Winchester SO23 4NR UK

Department Medicine KU Leuven 3000 Leuven Belgium

Department of Internal Medicine Geriatrics and Practical Medicine University Hospital Brno Masaryk's University 62500 Brno Czech Republic

Department of Paediatrics The Medical University of Warsaw 02 091 Warsaw Poland

Department of Paediatrics University of Insubria 21100 Varese Italy

Department of Pediatrics University Hospital Brno Masaryk's University 62500 Brno Czech Republic

Department Paediatrics Imperial College London London SW3 6LY UK

Pediatric Allergy Unit Department of Pediatrics University Hospitals of Geneva 1205 Geneva Switzerland

Pediatric Gastroenterology La Fe University Hospital 46026 Valencia Spain

Ramsay Group France et Clinique Marcel Sembat Paris Descartes University 92100 Boulogne Billancourt France

Schneider Children's Medical Center of Israel Institute of Gastroenterology Nutrition and Liver Diseases Petach Tikva 4920235 Israel

UZ Brussel KidZ Health Castle Vrije Universiteit Brussel 1090 Brussels Belgium

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