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

World Allergy Organization Journal . 3(4):57-161, April 2010.

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

Fiocchi, Alessandro (Chair); Brozek, Jan; Schünemann, Holger (Chair); Bahna, Sami L.; von Berg, Andrea; Beyer, Kirsten; Bozzola, Martin; Bradsher, Julia; Compalati, Enrico; Ebisawa, Motohiro; Guzman, Maria Antonieta; Li, Haiqi; Heine, Ralf G.; Keith, Paul; Lack, Gideon; Landi, Massimo; Martelli, Alberto; Rancé, Fabienne; Sampson, Hugh; Stein, Airton; Terracciano, Luigi; Vieths, Stefan

Author Information

Correspondence to: Alessandro Fiocchi, MD, Paediatric Division, Department of Child and Maternal Medicine, University of Milan Medical School at the Melloni Hospital, Milan 20129 Italy. E-mail:


INTRODUCTION: Allergy and clinical immunology societies have issued guidance for the management of food allergy.1,2 Guidelines are now regarded as translational research instruments, designed to provide cutting-edge benchmarks for good practice and bedside evidence for clinicians to use in an interactive learning context with their national or international scientific communities. In the management of cow’s milk allergy (CMA), both diagnosis and treatment would benefit from a reappraisal of the more recent literature, for “currentâ€�

guidelines summarize the achievements of the preceding decade, deal mainly with prevention,3–6 do not always agree on recommendations and date back to the turn of the century.7,8 In 2008, the World Allergy Organization (WAO) Special Committee on Food Allergy identified CMA as an area in need of a rationale-based approach, informed by the consensus reached through an expert review of the available clinical evidence, to make inroads against a burdensome, world-wide public health problem. It is in this context that the WAO Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) Guidelines was planned to provide physicians everywhere with a management tool to deal with CMA from suspicion to treatment. Targeted (and tapped for their expertise), both on the DRACMA panel or as nonsitting reviewers, were allergists, pediatricians (allergists and generalists), gastroenterologists, dermatologists, epidemiologists, methodologists, dieticians, food chemists, and representatives of allergic patient organizations. Ultimately, DRACMA is dedicated to our patients, especially the younger ones, whose burden of issues we hope to relieve through an ongoing and collective effort of more interactive debate and integrated learning.

Definitions: Adverse reactions after the ingestion of cow’s milk can occur at any age from birth and even among infants fed exclusively at the breast, but not all such reactions are of an allergic nature. A revision of the allergy nomenclature was issued in Europe in 20019 and was later endorsed by the WAO10 under the overarching definition of “milk hypersensitivity,â€� to cover nonallergic hypersensitivity (traditionally termed “cow’s milk intoleranceâ€�) and allergic milk hypersensitivity (or “cow’s milk allergyâ€�). The latter definition requires the activation of an underlying immune mechanism to fit. In DRACMA, the term “allergyâ€� will abide by the WAO definition (“allergy is a hypersensitivity reaction initiated by specific immunologic mechanismsâ€�). In most children with CMA, the condition can be immunoglobulin E (IgE)-mediated and is thought to manifest as a phenotypical expression of atopy, together with (or in the absence of) atopic eczema, allergic rhinitis and/or asthma. A subset of patients, however, have non-IgE mediated (probably cell-mediated) allergy and present mainly with gastro-intestinal symptoms in reaction to the ingestion of cow’s milk.

Saource : WAO Journal

Provided by

JL Taman bendungan Asahan  5 Jakarta Pusat, Jakarta Indonesia 10210

Phone : (021) 70081995 – 5703646

Clinical and Editor in Chief :
Dr Widodo judarwanto SpA
email :,

Information on this web site is provided for informational purposes    only and is not a substitute for professional medical advice. You  should   not use the information on this web site for diagnosing or  treating a   medical or health condition. You should carefully read all  product   packaging. If you have or suspect you have a medical problem,  promptly   contact your professional healthcare provider.

Copyright © 2011, Allergy Clinic Online Information Education Network. All rights reserved


Tinggalkan Balasan

Isikan data di bawah atau klik salah satu ikon untuk log in:


You are commenting using your account. Logout / Ubah )

Gambar Twitter

You are commenting using your Twitter account. Logout / Ubah )

Foto Facebook

You are commenting using your Facebook account. Logout / Ubah )

Foto Google+

You are commenting using your Google+ account. Logout / Ubah )

Connecting to %s