Background & Aim: Cow milk protein allergy (CMPA) has been documented in infants with exclusively breastfed at incidence of 0.5%-2.2%. The development of Cow’s milk-related symptom score (CoMiSS) was used as a tool to screen and raise awareness of CMPA in infancy depending on their clinical symptoms. Score greater than 12 is suggestive of CMPA. Here we assess the practical use of CoMiSS in a pediatrics gastroenterology outpatient department of a medical center of Northern Taiwan for exclusively breastfed infants presenting with symptoms suggestive of CMPA. 
Methods: Exclusively breastfed infants aged under 4 months with symptoms suggestive of CMPA were included in this observational study over a period of 2 years (March 2016-March 2018).
Results: A total of 43 infants were enrolled in the study. The mean age was 52 days. 65% of the infants were male and 35% were female. 56% of infants had inconsolable crying complaint followed by 35% with gastrointestinal complaints (regurgitation ([33%] and diarrhea [2%]) as well as 7% with skin manifestation (eczema). The overall mean and median of CoMiSS were 6.9 and 6.0. Only 1 infant out of 43 infants (2.3%) had CoMiSS greater than 12, where hypoallergic diet was suggested to the mother.
Conclusion:  In our study, CoMiSS probably can be used as a screening tool for CMPA in exclusively breastfed infants with symptoms suggestive of CMPA at pediatric gastroenterology outpatient department.

The Utility of Cow Milk Symptom Score in Exclusively Breastfed Taiwanese Infants with Symptoms Suggestive of Cow Milk Protein Allergy in Pediatrics Outpatient Department