World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines

Abstract

This article was originally published online on 23 April 2010 Alessandro Fiocchi, MD, Pediatric Division, Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan 20129, Italy. Holger Schünemann, MD,a Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West Hamilton, ON L8N 3Z5, Canada. Sami L. Bahna, MD, Pediatrics & Medicine, Allergy & Immunology, Louisiana State University Health Sciences Center, Shreveport, LA 71130. Andrea Von Berg, MD, Research Institute, Children’s department, Marien-Hospital, Wesel, Germany. Kirsten Beyer, MD, Charité Klinik für Pädiatrie m.S. Pneumologie und Immunologie, Augustenburger Platz 1, D-13353 Berlin, Germany. Martin Bozzola, MD, Department of Pediatrics, British Hos-pital-Perdriel 74-CABA-Buenos Aires, Argentina. Julia Bradsher, PhD, Food Allergy & Anaphylaxis Network, 11781 Lee Jackson Highway, Suite 160, Fairfax, VA 22033. Jan Brozek, MD,a Department of Clinical Epidemiology & Biostatistics, McMaster University Health Sciences Centre, 1200 Main Street West Hamilton, ON L8N 3Z5, Canada. Enrico Compalati, MD,a Allergy & Respiratory Diseases Clinic, Department of Internal Medicine. University of Genoa, 16132, Genoa, Italy. Motohiro Ebisawa, MD, Department of Allergy, Clinical Research Center for Allergy and Rheumatology, Sagami-hara National Hospital, Kanagawa 228-8522, Japan. Maria Antonieta Guzman, MD, Immunology and Allergy Division, Clinical Hospital University of Chile, Santiago, Chile. Santos Dumont 999. Haiqi Li, MD, Professor of Pediatric Division, Department of Primary Child Care, Children’s Hospital, Chongqing Medical University, China, 400014. Ralf G. Heine, MD, FRACP, Department of Allergy & Immunology, Royal Children’s Hospital, University of Melbourne, Murdoch Children’s Research Institute, Melbourne, Australia. Paul Keith, MD, Allergy and Clinical Immunology Division, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Gideon Lack, MD, King’s College London, Asthma-UK Centre in Allergic Mechanisms of Asthma, Department of Pediatric Allergy, St Thomas’ Hospital, London SE1 7EH, United Kingdom. Massimo Landi, MD, National Pediatric Healthcare System, Italian Federation of Pediatric Medicine, Territorial Pediat-ric Primary Care Group, Turin, Italy. Alberto Martelli, MD, Pediatric Division, Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan 20129, Italy. Fabienne Rancé, MD, Allergologie, Hôpital des Enfants, Pôle Médicochirurgical de Pédiatrie, 330 av. de Grande Bretagne, TSA 70034, 31059 Toulouse CEDEX, France. Hugh Sampson, MD, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, NY 10029-6574. Airton Stein, MD, Conceicao Hospital, Porto Alegre, Brazil. Luigi Terracciano, MD,a Pediatric Division, Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan 20129, Italy. Stefan Vieths, MD, Division of Allergology, Paul-EhrlichInstitut, Federal Institute for Vaccines and Biomedicines, Paul-Ehrlich-Str. 51-59, D-63225 Langen, Germany. aMember of the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group Amal Assa’ad, MD, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA. Carlos Baena-Cagnani, MD, LIBRA foundation Argentina, Division of Immunology and Respiratory Medicine, Department of Pediatric, Infantile Hospital Cordoba, Santa Rosa 381, 5000 Cordoba, Argentina. GR Bouygue, MSc, Pediatric Division, Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan 20129, Italy. Walter Canonica, MD, Allergy & Respiratory Diseases Clinic, Department of Internal Medicine. University of Genoa, 16132, Genoa, Italy. Christophe Dupont, MD, Service de gastroentérologie et nutrition, Hôpital Saint Vincent de Paul, 82, avenue Den-fert-Rochereau, 75674, Paris CEDEX 14, France. Yehia El-Gamal, MD, Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt. Matthew Fenton, MD, Asthma, Allergy and Inflammation Branch, National Institute of Allergy and Infectious Diseases, NIH, 6610 Rockledge Dr., Bethesda, MD 20892. Rosa Elena Huerta Hernandez, MD, Pediatric Allergy Clinic, Mexico City, Mexico. Manuel Martin-Esteban, MD, Allergy Department, Hospital Universitario La Paz, Madrid, Spain. Anna Nowak-Wegrzyn, MD, Jaffe Food Allergy Institute, Mount Sinai School of Medicine, One Gustave L. Levy Place, NY 10029-6574. Ruby Pawankar, MD, Department of Otolaryngology, Nippon Medical School, 1-1-5 Sendagi, Tokyo, 113 Japan. Susan Prescott, MD, School of Pediatrics and Child Health, University of Western Australia, Princess Margaret Hospital for Children, Perth, Australia. Patrizia Restani, PhD, Department of Pharmacological Sciences, Università degli Studi di Milano. Teresita Sarratud, MD, Department of Pediatrics, University of Carabobo Medical School at the Carabobo Hospital, Valencia, Venezuela. Aline Sprikkelmann, MD, Department of Pediatric Respiratory Medicine and Allergy, Emma Children’s Hospital Academic Medical Centre, Amsterdam, The Netherlands. 1:Introduction, p. 58.2:Methodology, p. 59.3:Epidemiology of CMA, p. 61.4:Allergens of Cow’s Milk, p. 65.5:Immunological Mechanisms of CMA, p. 71.6:Clinical History and Symptoms of CMA, p. 76.7:Diagnosis of CMA According to Preceding Guidelines, p. 85.8:The Elimination Diet in Work-Up of CMA, p. 88.9:Guidelines for Diagnosing CMA, p. 89.10:Oral Food Challenge Procedures in Diagnosis of CMA, p. 100.11:Natural History of CMA, p. 108.12:Treatment of CMA According to Preceding Guidelines, p. 112.13:When Can Milk Proteins Be Eliminated From Diet Without Substituting Cow’s Milk?, p. 117.14:Guidelines for Choosing a Replacement Formula, p. 119.15:Milks From Different Animals for Substituting Cow’s Milk, p. 124.16:Nutritional Considerations in CMA Treatment, p. 128.17:Choosing the Appropriate Substitute Formula in Different Presentations, p. 130.18:Grade Recommendations on Immunotherapy for CMA, p. 131.19:Unmet Needs, Recommendations for Research, Implementation of DRACMA, p. 133. Acknowledgements, p. 134 Appendix 1: Cow’s Milk Allergy Literature Search Algorithms, p. 135 Appendix 2: Evidence Profiles: Diagnosis of CMA, p. 144 Appendix 3: Evidence Profiles: Treatment of CMA, p. 154 Appendix 4: Evidence Profiles: OIT for Treatment of CMA, p. 160