Diagnosis and Rationale for Action Against Cow's Milk Allergy (DRACMA): a summary report.

Department of Child and Maternal Medicine, Melloni Hospital, Milan, Italy.
The Journal of allergy and clinical immunology (Impact Factor: 12.05). 12/2010; 126(6):1119-28.e12. DOI: 10.1016/j.jaci.2010.10.011
Source: PubMed

ABSTRACT 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.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Characterisation of the specific antibody response, including the epitope binding pattern, is an essential task for understanding the molecular mechanisms of food allergy. Examination of antibody formation in a controlled environment requires animal models. The purpose of this study was to examine the amount and types of antibodies raised against three cow's milk allergens; β-lactoglobulin (BLG), α-lactalbumin (ALA) and β-casein upon oral or intraperitoneal (i.p.) administration. A special focus was given to the relative amount of antibodies raised against linear versus conformational epitopes.
    Clinical and translational allergy. 01/2014; 4:25.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Food allergy is an aberrant immune-mediated reaction against harmless food substances, such as cow's milk proteins. Due to its very early introduction, cow's milk allergy is one of the earliest and most common food allergies. For this reason cow's milk allergy can be recognized as one of the first indications of an aberrant inflammatory response in early life. Classically, cow's milk allergy, as is true for most other allergies as well, is primarily associated with abnormal humoral immune responses, that is, elevation of specific immunoglobulin E levels. There is growing evidence indicating that cellular components of both innate and adaptive immunity play significant roles during the pathogenesis of cow's milk allergy. This is true for the initiation of the allergic phenotype (stimulation and skewing towards sensitization), development and outgrowth of the allergic disease. This review discusses findings pertaining to roles of cellular immunity in allergic inflammation, and tolerance induction against cow's milk proteins. In addition, a possible interaction between immune mechanisms underlying cow's milk allergy and other types of inflammation (infections and noncommunicable diseases) is discussed.
    Mediators of Inflammation 01/2014; 2014:249784. · 2.42 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The treatment for cow's milk protein allergy (CMPA) is a diet with an extensive hydrolysate. This study aimed to determine whether a whey (eWH) or casein hydrolysate (eCH) is the best option. Infants with suspected CMPA were treated with an eWH or eCH and efficacy was assessed with a symptom-based score developed by the authors. Diagnosis of CMPA was based on a positive challenge. If positive, the same eHF/eCH was continued. If negative a standard starter and follow-up formula was given up to the age of 12 months. An open challenge was performed on 85/116 (73%) infants suspected of CMPA on clinical grounds and was positive in 59/85 (69%). After one month the symptom-based scores in both groups showed significant statistical and clinical reductions and total and specific IgE and skin prick test results were similar. Both hydrosylates were enriched with probiotics, which were recovered in the gastro-intestinal flora. The eWH-Standard Formula sequence led to better growth at the age of one year than the other three feeding regimens tested. The eWH and eCH are equally effective. The symptom-based score is a useful tool to evaluate the efficacy of dietary treatment in infants with CMPA. This article is protected by copyright. All rights reserved.
    Acta Paediatrica 07/2013; · 1.97 Impact Factor

Full-text (2 Sources)

Available from
May 26, 2014