Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 30;17(9):1563.
doi: 10.3390/nu17091563.

Evaluating the Need for Pre-CoMiSS™, a Parent-Specific Cow's Milk-Related Symptom Score: A Qualitative Study

Yvan Vandenplas  1 , Kateřina Bajerová  2 , Christophe Dupont  3 , Mikael Kuitunen  4 , Rosan Meyer  5 , Anna Nowak-Wegrzyn  6   7 , Carmen Ribes-Koninckx  8 , Silvia Salvatore  9 , Raanan Shamir  10   11 , Annamaria Staiano  12 , Hania Szajewska  13 , Carina Venter  14 , Sue Jones  15 , Anette Järvi  15 , Catherine Couchepin  16
Affiliations

Evaluating the Need for Pre-CoMiSS™, a Parent-Specific Cow's Milk-Related Symptom Score: A Qualitative Study

Yvan Vandenplas et al. Nutrients. .

Abstract

Background/Objectives: Cow's milk allergy (CMA) presents a significant clinical burden. The Cow's Milk-related Symptom Score (CoMiSS™) is a widely used clinical screening tool designed to raise awareness of CMA among healthcare professionals. This qualitative study aimed to assess the need for a parent-reported CoMiSS™ tool (Pre-CoMiSS™) and explore its potential usefulness for parents and primary care physicians (PCPs). Methods: Participants were parents of infants aged 2-12 months and PCPs from Germany, Sweden, Spain, and the United Kingdom (UK) selected from a local panel of potential respondents. Interviews, conducted by experienced qualitative research moderators, consisted of pre-decided standardised questions. Thematic analysis was undertaken, and themes were derived from the data. Results: A total of 26 parent interviews and 18 primary care physician interviews were conducted. Parents from all countries found the Pre-CoMiSS™ tool helpful for understanding their baby's signs, easy to use, and useful for facilitating consultation with the physician. Physicians in the UK, Spain, and Sweden found that the Pre-CoMiSS™ tool was helpful for improving symptom reporting and for medical consultations; however, in Germany, physicians had mixed opinions, expressing concerns that the tool might increase parental anxiety, lead to overdiagnosis of CMA, and add to their workload. Conclusions: A parent-specific tool for recording cow's milk-related symptoms was generally well received by parents and most physicians, though concerns about parental anxiety and workload were noted, particularly in Germany. With further validation and refinement, Pre-CoMiSS™ may be a useful tool for parents to record their infant's symptoms related to feeding and support PCPs in considering CMA in these infants.

Keywords: CoMiSS™; cow’s milk; cow’s milk allergy; crying; distress; food allergy; infant; regurgitation.

PubMed Disclaimer

Conflict of interest statement

Y.V. has participated as a clinical investigator, advisory board member, consultant, and/or speaker for Abbott Nutrition, Alba Health, Arla, Biogaia, Danone, ELSE Nutrition, Friesland Campina, Nestlé Health Science, Nestlé Nutrition Institute, Nutricia, Pileje, and United Pharmaceuticals (Novalac). K.B. has participated as a consultant and/or speaker for Danone, Nestlé Health Science, Nestlé Nutrition Institute, and Nutricia. K.B. reports honoraria from Abbott, Danone, and Nestlé. C.D. has participated as a consultant for and/or reports speaker fees and travel support from Abbott, Nestlé Health Science, Danone, Mead Johnson, and Novalac; he is an employee of Clinique Marcel Sembat, Ramsay Group. M.K. reports being an advisory board member for Nestlé Health Science. R.M. reports honoraria for academic lectures from Mead Johnson, Abbott Laboratories, Nestlé, and Nutricia/Danone; is Principal Investigator for a study funded by Nutricia/Danone; and has provided consultancy support for Nestlé Healthcare, Abbott Laboratories, and Else Nutrition. A.N.-W. reports research support from DBV Technologies and Siolta Therapeutics; reports speaking fees from Nestlé, Danone, and Thermo Fisher; reports royalties from UpToDate; and serves as Associate Editor for the Annals of Allergy, Asthma & Immunology, Chair of the ABAI Board of Directors, Director of the AAAAI Board, and Chair of the Medical Advisory Board of the International FPIES Association. C.R.-K. reports honoraria from Danone, Nestlé, and Ordesa. S.S. has participated as a clinical investigator, advisory board member, consultant, and/or speaker for Aurora Biofarma, Danone, DMG Italia, Erbozeta, Humanas, Nestlé Health Science, and Noos. R.S. has participated as a clinical investigator, advisory board member, consultant, and/or speaker for Abbott, Elgan, Else, Nestlé Nutrition Institute, Nestlé Health Science, NGS, Nutricia, Soremartec, Tracells, and Ukko. A.S. is a clinical investigator for Aboca, AstraZeneca, Janssen Biologics B.V., and Novalac; is a consultant for Aboca, Abbott, and Novalac, was a clinical investigator for Eli Lilly Cork Limited and PAREXEL International Srl, and was a consultant for Pileje. H.S. serves as a board member of the International Scientific Association for Probiotics and Prebiotics, a role that is unpaid and voluntary; she has participated as a clinical investigator, advisory board member, consultant, and speaker for several companies, including Arla, BioGaia, Biocodex, Danone, Dicofarm, Nestlé, NNI, Nutricia, Mead Johnson, and Novalac. C.V. has provided lecture consultancy for Danone, Reckitt, Nestle Nutrition Institute, and Novolac. S.J. and A.J. are employees of Nestlé Health Science. C.C. is an employee of Ipsos SA; Ipsos SA was contracted by Nestlé to carry out this qualitative research.

Figures

Figure 1
Figure 1
Development of Pre-CoMiSS™. CoMiSS—Cow’s Milk-related Symptom Score; ESPGHAN—European Society for Paediatric Gastroenterology, Hepatology and Nutrition; Pre-CoMiSS—parent-reported CoMiSS.
Figure 2
Figure 2
Parent and primary care physician themes. CMA—cow’s milk allergy; CoMiSS—Cow’s Milk-related Symptom Score; Pre-CoMiSS—parent-reported CoMiSS.
Figure 3
Figure 3
Illustration of the level of awareness and attitudes. CMA—cow’s milk allergy.
Figure 4
Figure 4
Parent key performance indicators of Pre-CoMiSS™. Green = high; yellow = intermediate; Pre-CoMiSS—parent-reported Cow’s Milk-related Symptom Score.
Figure 5
Figure 5
Illustration of primary care physician awareness of and interest in CoMiSS™. CoMiSS—Cow’s Milk-related Symptom Score.
Figure 6
Figure 6
Primary care physician key performance indicators of Pre-CoMiSS™: (a) UK, Sweden, and Spain; (b) Germany. Green = high; yellow = intermediate; red = low. Note that in Germany, understanding and relevance were polarised; Pre-CoMiSS—parent-reported Cow’s Milk-related Symptom Score.
See this image and copyright information in PMC

References

    1. Edwards C.W., Younus M.A. Cow Milk Allergy. StatPearls Publishing; Treasure Island, FL, USA: 2024. - PubMed
    1. Meyer R., Vandenplas Y., Lozinsky A.C., Vieira M.C., Berni Canani R., du Toit G., Dupont C., Giovannini M., Uysal P., Cavkaytar O., et al. Diagnosis and management of food allergy-induced constipation in young children-An EAACI position paper. Pediatr. Allergy Immunol. 2024;35:e14163. doi: 10.1111/pai.14163. - DOI - PubMed
    1. Rona R.J., Keil T., Summers C., Gislason D., Zuidmeer L., Sodergren E., Sigurdardottir S.T., Lindner T., Goldhahn K., Dahlstrom J., et al. The prevalence of food allergy: A meta-analysis. J. Allergy Clin. Immunol. 2007;120:638–646. doi: 10.1016/j.jaci.2007.05.026. - DOI - PubMed
    1. Bognanni A., Chu D.K., Firmino R.T., Arasi S., Waffenschmidt S., Agarwal A., Dziechciarz P., Horvath A., Jebai R., Mihara H., et al. World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guideline update-XIII-Oral immunotherapy for CMA–Systematic review. World Allergy Organ. J. 2022;15:100682. doi: 10.1016/j.waojou.2022.100682. - DOI - PMC - PubMed
    1. Schoemaker A.A., Sprikkelman A.B., Grimshaw K.E., Roberts G., Grabenhenrich L., Rosenfeld L., Siegert S., Dubakiene R., Rudzeviciene O., Reche M., et al. Incidence and natural history of challenge-proven cow’s milk allergy in European children--EuroPrevall birth cohort. Allergy. 2015;70:963–972. doi: 10.1111/all.12630. - DOI - PubMed

Grants and funding

LinkOut - more resources