Abstract
In 2008 the World Allergy Organization (WAO) verified that the existing guidelines on CMA were usually national position papers reflecting local views and needs, with flexible, sometimes evidence-based, strategies].Then, a global guideline for IgE-mediated CMA from diagnosis to treatment was developed using the GRADE approach. We review here the first steps of Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA) together with the changes in diagnostic and therapeutic behavior generated by the new guideline.
Highlights
In 2008 the World Allergy Organization (WAO) verified that the existing guidelines on CMA were usually national position papers reflecting local views and needs, with flexible, sometimes evidence-based, strategies [1,2,3,4]
After the first publication in WAO Journal in April 2010, DRACMA was replicated in an indexed journal [14]
The subsequently published NIAID guidelines [16] widely referred to DRACMA, cited by dozens
Summary
In 2008 the World Allergy Organization (WAO) verified that the existing guidelines on CMA were usually national position papers reflecting local views and needs, with flexible, sometimes evidence-based, strategies [1,2,3,4]. This is so evident that in case OFC is performed out of a research setting, sensitization tests may not be necessary (recommendation 1.1) This is counterintuitive for pediatric allergists, as correct diagnosis of CMA, starting with a suspicion and ending with the OFC, traditionally passes through sensitization tests including SPT, atopy patch tests, and specific IgE determination. Treatment with CMA replacement formulas In its therapeutic guidelines DRACMA recommended a milk-free diet for cases of IgE-mediated CMA and the use of appropriate alternative formulas up to at least 2 years of age to meet the nutritional needs of these very young children (Table 1). The complete recommendation set is available at http://www.worldallergy.org/publications/WAO_DRACMA_guidelines.pdf According to these recommendations, when a substitute formula is needed a milk-based extensively hydrolyzed formula (eHF) is the first choice except in case of anaphylaxis or eosinophilic esophagitis, where AAF is recommended. Clinical presentation Anaphylaxis Acute urticaria or angioedema Atopic dermatitis Immediate gastrointestinal allergy Allergic eosinophilic oesophagitis Gastroesophageal reflux disease (GERD) Cow’s milk protein-induced enteropathy
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
