What’s next for DRACMA?

Dahdah, Lamia; Fierro, Vincenzo; Mennini, Maurizio; Arasi, Stefania; Fiocchi, Alessandro

doi:10.1080/1744666x.2018.1500900

Cited by 2 publications

(2 citation statements)

References 23 publications

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“…In synthesis, reconciling the diagnostic procedures for the different forms of CMA will be a challenge for the new DRACMA guidelines. 19 A peculiar issue to consider, in the treatment of CMA, given the pivotal importance of maternal milk for children up to 24/36 months of age, is to confirm the evidence underlying the suggestion of cow's milk (CM) elimination diet for mothers breastfeeding allergic infants. 20 In the past 10 years, the involvement of formulas in the management of CMA has been profoundly expanded, with extensively hydrolyzed formulas (eHFs), 21 rice hydrolyzed formula (HRF), 22 amino acid formulae (AAF), 23 camel and dromedary milk, 24 and donkey milk 25 receiving increasing attention from the health community and being implemented in medical practice.…”

Section: -2020: Open Questions In Diagnosis Therapy and Immunotherapy Of Cmamentioning

confidence: 99%

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions

Fiocchi

Bognanni

Brožek

et al. 2022

World Allergy Organization Journal

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Since the World Allergy Organization (WAO) Diagnosis and Rationale against Cow's Milk Allergy (DRACMA) Guidelines were published 10 years ago, new evidence has accumulated about the diagnosis, therapy, and specific immunotherapy for cow's milk allergy (CMA). For this reason, WAO has felt the need to update the guidelines. We introduce here this update. The new DRACMA guidelines aim to comprehensively address the guidance on diagnosis and therapy of both IgE non-IgE-mediated forms of cow's milk allergy in children and adults. They will be divided into 18 chapters, each of which will be dedicated to an aspect. The focus will be on the meta-analyzes and recommendations that will be expressed for the 3 most relevant clinical aspects: (a) the diagnostic identification of the condition; (b) the choice of the replacement formula in case of CMA in infancy when the mother is not able to breastfeed, and (c) the use of specific immunotherapy for cow's milk protein allergy.

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Section: -2020: Open Questions In Diagnosis Therapy and Immunotherapy Of Cmamentioning

confidence: 99%

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions

Fiocchi

Bognanni

Brožek

et al. 2022

World Allergy Organization Journal

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“…For the diagnosis, Skin Prick test and/or sIgE tests are recommended, although positive results merely indicate sensitisation and do not confirm alone the disease [22,23]. The DRACMA guidelines have previously provided evidence-based recommendations on the use of the OFC as a 'gold standard' for IgE-CMA [23] and an updated version has been announced to be shortly published [24]. Although OFC remains the gold standard for the diagnosis, data show that OFC results are not predictive of the severity of subsequent reactions [25] and there is no direct correlation between the eliciting threshold experienced by children during an OFC and the reaction's severity upon accidental exposure [26].…”

Section: Ige-cow's Milk Allergymentioning

confidence: 99%

Cow's milk allergy

Arasi

Cafarotti

Fiocchi

2022

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of reviewTo highlight the most recent insights on cow's milk allergy (CMA), its treatment, and management.Recent findingsCMA is one of the most common food allergies among children. Burdened by the risk for fatal reaction, CMA may imply also a severe impairment of health-related quality of life at individual and family level as well as well as individual and societal costs. The updated Diagnosis and Rationale for Action against Cow's Milk Allergy series is going to provide a series of manuscripts that will offer a comprehensive state-of-the-art specifically on CMA, including international evidence-based recommendations. The current results from randomized clinical trials highlight that oral immunotherapy may be effective by itself in providing desensitization. Preliminary data suggest that biologicals such as omalizumab may be able to increase the threshold of reactivity to milk or several foods (if multiple food allergies) without requiring allergen exposure. Breastfeeding is the first choice for infants with CMA. Extensively hydrolyzed formula and amino-acid formula are valid alternatives and may be particularly helpful when eliminating multiple foods, with severe complex gastrointestinal food allergies, eosinophilic esophagitis, severe eczema, or symptoms while exclusively breastfeeding. Heed is needed to ensure the formula is nutritionally sufficient. Due to a high degree of cross-reactivity with cow's milk proteins and risk for allergic reactions, goats’ milk or other mammals’ milk should not be used.SummaryThe adoption and implementation of evidence-based recommendations may guide a proper diagnostics and management and awaited advances in knowledge will allow the development of a personalized treatment tailored on the specific CMA patient's profile.

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What’s next for DRACMA?

Cited by 2 publications

References 23 publications

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions

World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines update – I – Plan and definitions

Cow's milk allergy

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