The global impact of the DRACMA guidelines cow's milk allergy clinical practice

The World Allergy Organization Journal
Alessandro FiocchiJan Brozek

Abstract

The 2010 Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow's milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment. Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and international level. We describe some economic consequences of their application. DRACMA are the most cited CMA guidelines, and the second cited guidelines on food allergy. Many subsequent guidelines took stock of DRACMA's metanalyses adapting recommendations to the local context. Some of these chose not to consider OFC as an absolute requirement for the diagnosis of CMA. Studies on their implementation show that in this case, the treatment costs may increase and there is a risk of overdiagnosis. Interestingly, we observed a reduction in the cost of alternative formulas follow...Continue Reading

Citations

Jul 18, 2018·Expert Review of Clinical Immunology·Lamia DahdahAlessandro Fiocchi
Jan 12, 2019·Current Opinion in Allergy and Clinical Immunology·Lamia DahdahAlessandro Fiocchi
Dec 22, 2019·Sensors·Monika NehraGiovanna Marrazza
Feb 29, 2020·Immunity, Inflammation and Disease·Vincenzo FierroJesus Jiménez
Mar 21, 2020·Current Opinion in Allergy and Clinical Immunology·Alessandro Fiocchi, Motohiro Ebisawa
Mar 1, 2019·Nutrients·Benjamín Martín Martínez, Maria José López Liñán
Apr 30, 2020·Current Opinion in Allergy and Clinical Immunology·Alessandro Fiocchi, Motohiro Ebisawa
Apr 6, 2019·Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology·Irene BertiGiorgio Longo
Dec 15, 2020·Frontiers in Pediatrics·Elvira VerduciDiego G Peroni
May 11, 2021·Pediatric Allergy and Immunology : Official Publication of the European Society of Pediatric Allergy and Immunology·Georgina ThompsonChristopher Hyde

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