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. 2023 Mar 16;15(3):84–102. doi: 10.4253/wjge.v15.i3.84

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