World Allergy Organization Journal (Aug 2024)
World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines update – XVI - Nutritional management of cow's milk allergy
- Carina Venter,
- Rosan Meyer,
- Marion Groetch,
- Anna Nowak-Wegrzyn,
- Maurizio Mennini,
- Ruby Pawankar,
- Rose Kamenwa,
- Amal Assa'ad,
- Shriya Amara,
- Alessandro Fiocchi,
- Antonio Bognanni,
- Ignacio Ansotegui,
- Stefania Arasi,
- Sami L. Bahna,
- Roberto Berni Canani,
- Martin Bozzola,
- Jan Brozek,
- Derek Chu,
- Lamia Dahdah,
- Christophe Dupont,
- Motohiro Ebisawa,
- Ramon T. Firmino,
- Elena Galli,
- Gideon Lack,
- Haiqi Li,
- Alberto Martelli,
- Nikolas G. Papadopoulos,
- Maria Said,
- Mario Sánchez-Borges,
- Holger Schunemann,
- Raanan Shamir,
- Jonathan Spergel,
- Hania Szajewska,
- Luigi Terracciano,
- Yvan Vandenplas,
- Susan Waserman,
- Amena Warner,
- Gary W.K. Wong
Affiliations
- Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO, USA; Corresponding author.
- Rosan Meyer
- Department of Medicine, Imperial College, London. Department Medicine KU Leuven, Belgium. Department Nutrition and Dietetics, Winchester University, UK
- Marion Groetch
- Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai. New York, NY, USA
- Anna Nowak-Wegrzyn
- Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Childrens' Hospital, New York, NY, USA; Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland
- Maurizio Mennini
- NESMOS Department, Sapienza University, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy
- Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
- Rose Kamenwa
- Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya
- Amal Assa'ad
- Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center – Cincinnati Ohio, USA
- Shriya Amara
- University of California, Los Angeles, USA
- Alessandro Fiocchi
- Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
- Antonio Bognanni
- Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele (Milano), Italy; Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada
- Ignacio Ansotegui
- Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain
- Stefania Arasi
- Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
- Sami L. Bahna
- Allergy & Immunology Section, Louisiana State University Health Sciences Center – Shreveport, Louisiana, USA
- Roberto Berni Canani
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
- Martin Bozzola
- Department of Pediatrics, Section of Pediatric Allergy and Immunology. British Hospital. Buenos Aires, Argentina
- Jan Brozek
- McMaster's University, Hamilton, Ontario, Canada
- Derek Chu
- McMaster's University, Hamilton, Ontario, Canada
- Lamia Dahdah
- Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy
- Christophe Dupont
- Paris Descartes University, Pediatric Gastroenterology, Necker Hospital, Paris, Clinique Marcel Sembat, Boulogne-Billancourt, France
- Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan
- Ramon T. Firmino
- Faculty of Medical Sciences of Campina Grande, UNIFACISA University Centre, Campina Grande, Paraiba, Brazil
- Elena Galli
- Pediatric Allergy Unit, San Pietro Hospital - Fatebenefratelli, Rome, Italy
- Gideon Lack
- Department of Woman and Childrens' Health/Peter Gorer Department of Immunobiology, School of Life Course Sciences, Faculty of Life Sciences & Medicine, King's College London, UK; Evelina London Children's Hospital, Guy's St Thomas' Hospital, NHS Foundation Trust, London, UK
- Haiqi Li
- Department of Primary Child Care, Children's Hospital, Chongqing Medical University, China
- Alberto Martelli
- Allergist, Edmondo de Amicis School, Milan, Italy
- Nikolas G. Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK; Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece
- Maria Said
- Allergy & Anaphylaxis Australia (AAA), Castle Hill, New South Wales, Australia
- Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico - Docente La Trinidad and Clínica El Avila, Caracas, Venezuela
- Holger Schunemann
- McMaster's University, Hamilton, Ontario, Canada; Cochrane Canada and McMaster University GRADE Center, Hamilton, Ontario, Canada
- Raanan Shamir
- Institute for Gastroenterology, Nutrition and Liver Diseases, Schneider Children's Medical Center, Lea and Arieh Pickel Chair for Pediatric Research, Sackler Faculty of Medicine, Tel Aviv University, Petach Tikva, Israel
- Jonathan Spergel
- Division of Allergy-Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA
- Hania Szajewska
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
- Luigi Terracciano
- Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy
- Yvan Vandenplas
- KidZ Health Castle, Department of Pediatrics UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
- Susan Waserman
- Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Amena Warner
- Allergy UK, London, England, UK
- Gary W.K. Wong
- Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China
- Journal volume & issue
-
Vol. 17,
no. 8
p. 100931
Abstract
Cow's milk allergy (CMA) is one of the most common presentations of food allergy in early childhood. Management of CMA involves individualized avoidance of cow's milk and other mammalian milk and foods containing these. Optimal elimination of cow's milk avoidance includes: label reading; information about safe and nutritious substitute foods; appropriate choice of infant formula or a plant-based food; establishing tolerance to baked milk and monitoring nutritional intake and growth. Substitute formulas are divided into soy formula (not hydrolyzed), milk-based extensively hydrolyzed formulas, rice based extensive, and partially hydrolyzed formulas and amino acid-based formulas. The use of other mammalian milks is not recommended for the management of cow's milk allergy due to a high level of cross-reactivity and nutritional concerns. For toddlers who are eating well, children, and adults, a suitable plant-based beverage may be a suitable alternative to a specialized formula, following careful nutritional considerations. Families need to be instructed on finding suitable nutritious foods and how to prepare suitable meals at home. Individuals with CMA also need to know how to identify and treat acute severe reactions.
