Table 3.

Updated version of the Cow's Milk-related Symptom Score (CoMiSS) used to evaluate children suspected of cow’s milk protein allergy

Symptom	Characteristics and frequency	Score
Crying assessed by parents and without any obvious cause ≥ 1 wk, and not related to infection	≤ 1 h/d	0
	1.0-1.5 h/d	1
	1.5-2.0 h/d	2
	2-3 h/d	3
	3-4 h/d	4
	4-5 h/d	5
	≥ 5 h/d	6
Regurgitation ≥ 1 wk	0-2 episodes/d	0
	3-5 episodes (volume < 5 mL)/d	1
	> 5 episodes of volume > 5 mL	2
	> 5 episodes (volume < 50% of feeds)/d	3
	Small volume and happens > 30 min after each feed	4
	Regurgitation of ≥ 50% volume of a feed in ≥ 50% of total feeds	5
	Regurgitation of the complete feed after each feeding	6
Stool: Brussels Infant and Toddlers Stool Scale (BITSS); no change ≥ 1 wk	Hard stools	4
	Formed stools	0
	Loose stools not related to infection	4
	Watery stools not related to infection	6
Skin symptoms not related to infection	Atopic eczema ≥ 1/wk
	Absent	0
	Mild	1
	Moderate	2
	Severe	3
	Acute urticaria/angioedema that directly related to cow’s milk
	No	0
	Yes	1
Respiratory symptoms not related to infection ≥ 1 wk	No respiratory symptoms	0
	Slight symptoms	1
	Mild symptoms	2
	Severe symptoms	3