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How DRACMA changes clinical decision for the individual patient in CMA therapy

Terracciano, Luigi; Schünemann, Holger; Brozek, Jan; Agostoni, Carlo; Fiocchi, Alessandroon behalf of the DRACMA Implementation Committee, World Allergy Organisation

Current Opinion in Allergy and Clinical Immunology: June 2012 - Volume 12 - Issue 3 - p 316–322
doi: 10.1097/ACI.0b013e3283535bdb
FOOD ALLERGY: Edited by Alessandro Fiocchi and Julie Wang

Purpose of review To describe the impact of the diagnosis and rationale for action against cow's milk allergy (DRACMA) guidelines on the decision process in the therapy of cow's milk allergy (CMA).

Recent findings We report here the experience of a 2-year application of DRACMA worldwide. Variations in the socioeconomic profile of CMA sufferers and their context can modify the application of DRACMA recommendations. As an example, we use the country-by-country modifications of the social structure and the modifications of the prices for special formula in Italy.

Summary The DRACMA guidelines were issued to inform formula choice for CMA treatment by integrating patients’ underlying values, preferences and remarks into grading of recommendations assessment, development and evaluation (GRADE) recommendations, which serve to facilitate their interpretation. This method allows every pediatrician/allergist to follow the changing variables of formulas (cost, palatability, nutritional value) and tailor their prescription for individual patients accordingly. The art of CMA treatment has always relied on physicians’ interpretation and the goal of the DRACMA guidelines is to provide a rationale-based and evidence-based indication for choosing an appropriate formula.

aDepartment of Pediatrics, Melloni University Hospital, Milan, Italy

bDepartment of Clinical Epidemiology and Biostatistics McMaster University Health Sciences Centre, Main Street West, Hamilton, Ontario, Canada

cDepartment of Pediatrics, Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico, University of Milan, Milan, Italy

Correspondence to Luigi Terracciano, MD, Pediatric Department, Melloni Hospital, Via M Melloni 52, 20129 Milan, Italy. E-mail:

Copyright © 2012 Wolters Kluwer Health, Inc. All rights reserved.