Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA): a summary report.
The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge.
Department of Child and Maternal Medicine, Melloni Hospital, Milan, Italy. allerg@tin.it
Alessandro
A
Fiocchi
Holger J
HJ
Schünemann
Jan
J
Brozek
Patrizia
P
Restani
Kirsten
K
Beyer
Riccardo
R
Troncone
Alberto
A
Martelli
Luigi
L
Terracciano
Sami L
SL
Bahna
Fabienne
F
Rancé
Motohiro
M
Ebisawa
Ralf G
RG
Heine
Amal
A
Assa'ad
Hugh
H
Sampson
Elvira
E
Verduci
G R
GR
Bouygue
Carlos
C
Baena-Cagnani
Walter
W
Canonica
Richard F
RF
Lockey
D000818:Animals; D002417:Cattle; D003245:Consensus Statements as Topic; D006801:Humans; D007167:Immunotherapy; D046228:Microarray Analysis; D016269:Milk Hypersensitivity / Q000175:diagnosis* / Q000453:epidemiology / Q000276:immunology / Q000628:therapy*; D057089:Pathology, Molecular / Q000639:trends; D017410:Practice Guidelines as Topic; D058028:Research Report; D057170:Translational Research, Biomedical