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 Venter¹, Rosan Meyer², Marion Groetch³, Anna Nowak-Wegrzyn^{4

5}, Maurizio Mennini⁶, Ruby Pawankar⁷, Rose Kamenwa⁸, Amal Assa'ad⁹, Shriya Amara¹⁰, Alessandro Fiocchi¹¹, Antonio Bognanni^{12

13

14}; DRACMA Panel

Collaborators, Affiliations

Collaborators

DRACMA Panel:
Ignacio Ansotegui¹⁵, Stefania Arasi¹¹, Sami L Bahna¹⁶, Roberto Berni Canani¹⁷, Martin Bozzola¹⁸, Jan Brozek¹⁹, Derek Chu¹⁹, Lamia Dahdah¹¹, Christophe Dupont²⁰, Motohiro Ebisawa²¹, Ramon T Firmino²², Elena Galli²³, Gideon Lack^{24

25}, Haiqi Li²⁶, Alberto Martelli²⁷, Nikolas G Papadopoulos^{28

29}, Maria Said³⁰, Mario Sánchez-Borges³¹, Holger Schunemann^{19

32}, Raanan Shamir³³, Jonathan Spergel³⁴, Hania Szajewska³⁵, Luigi Terracciano³⁶, Yvan Vandenplas³⁷, Susan Waserman³⁸, Amena Warner³⁹, Gary Wk Wong⁴⁰

Affiliations

¹ Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
² Department of Medicine, Imperial College, London. Department Medicine KU Leuven, Belgium. Department Nutrition and Dietetics, Winchester University, UK.
³ Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai. New York, NY, USA.
⁴ Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Childrens' Hospital, New York, NY, USA.
⁵ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
⁶ NESMOS Department, Sapienza University, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
⁷ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁸ Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
⁹ Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center - Cincinnati Ohio, USA.
¹⁰ University of California, Los Angeles, USA.
¹¹ Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy.
¹² Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele (Milano), Italy.
¹³ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.
¹⁴ Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada.
¹⁵ Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
¹⁶ Allergy & Immunology Section, Louisiana State University Health Sciences Center - Shreveport, Louisiana, USA.
¹⁷ Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.
¹⁸ Department of Pediatrics, Section of Pediatric Allergy and Immunology. British Hospital. Buenos Aires, Argentina.
¹⁹ McMaster's University, Hamilton, Ontario, Canada.
²⁰ Paris Descartes University, Pediatric Gastroenterology, Necker Hospital, Paris, Clinique Marcel Sembat, Boulogne-Billancourt, France.
²¹ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
²² Faculty of Medical Sciences of Campina Grande, UNIFACISA University Centre, Campina Grande, Paraiba, Brazil.
²³ Pediatric Allergy Unit, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
²⁴ 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.
²⁵ Evelina London Children's Hospital, Guy's St Thomas' Hospital, NHS Foundation Trust, London, UK.
²⁶ Department of Primary Child Care, Children's Hospital, Chongqing Medical University, China.
²⁷ Allergist, Edmondo de Amicis School, Milan, Italy.
²⁸ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
²⁹ Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece.
³⁰ Allergy & Anaphylaxis Australia (AAA), Castle Hill, New South Wales, Australia.
³¹ Allergy and Clinical Immunology Department, Centro Médico - Docente La Trinidad and Clínica El Avila, Caracas, Venezuela.
³² Cochrane Canada and McMaster University GRADE Center, Hamilton, Ontario, Canada.
³³ 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.
³⁴ Division of Allergy-Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
³⁵ Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
³⁶ Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy.
³⁷ KidZ Health Castle, Department of Pediatrics UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
³⁸ Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada.
³⁹ Allergy UK, London, England, UK.
⁴⁰ Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China.

PMID: 39228431
PMCID: PMC11369454
DOI: 10.1016/j.waojou.2024.100931

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 et al. World Allergy Organ J. 2024.

. 2024 Aug 12;17(8):100931.

doi: 10.1016/j.waojou.2024.100931. eCollection 2024 Aug.

Authors

Collaborators

DRACMA Panel:
Ignacio Ansotegui¹⁵, Stefania Arasi¹¹, Sami L Bahna¹⁶, Roberto Berni Canani¹⁷, Martin Bozzola¹⁸, Jan Brozek¹⁹, Derek Chu¹⁹, Lamia Dahdah¹¹, Christophe Dupont²⁰, Motohiro Ebisawa²¹, Ramon T Firmino²², Elena Galli²³, Gideon Lack^{24

25}, Haiqi Li²⁶, Alberto Martelli²⁷, Nikolas G Papadopoulos^{28

29}, Maria Said³⁰, Mario Sánchez-Borges³¹, Holger Schunemann^{19

32}, Raanan Shamir³³, Jonathan Spergel³⁴, Hania Szajewska³⁵, Luigi Terracciano³⁶, Yvan Vandenplas³⁷, Susan Waserman³⁸, Amena Warner³⁹, Gary Wk Wong⁴⁰

Affiliations

¹ Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Aurora, CO, USA.
² Department of Medicine, Imperial College, London. Department Medicine KU Leuven, Belgium. Department Nutrition and Dietetics, Winchester University, UK.
³ Department of Pediatrics, Division of Allergy and Immunology, Icahn School of Medicine at Mount Sinai. New York, NY, USA.
⁴ Department of Pediatrics, NYU Grossman School of Medicine, Hassenfeld Childrens' Hospital, New York, NY, USA.
⁵ Department of Pediatrics, Gastroenterology and Nutrition, Collegium Medicum, University of Warmia and Mazury, Olsztyn, Poland.
⁶ NESMOS Department, Sapienza University, Pediatric Unit, Sant'Andrea University Hospital, Rome, Italy.
⁷ Department of Pediatrics, Nippon Medical School, Tokyo, Japan.
⁸ Department of Paediatrics and Child Health, Aga Khan University Hospital, Nairobi, Kenya.
⁹ Division of Allergy and Immunology, Cincinnati Children's Hospital Medical Center - Cincinnati Ohio, USA.
¹⁰ University of California, Los Angeles, USA.
¹¹ Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio, 4, Rome 00165, Italy.
¹² Clinical Epidemiology and Research Center (CERC), Humanitas University & Humanitas Research Hospital, Via Rita Levi Montalcini 4, 20090, Pieve Emanuele (Milano), Italy.
¹³ Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada.
¹⁴ Department of Medicine, Evidence in Allergy Group, McMaster University, Hamilton, Ontario, Canada.
¹⁵ Department of Allergy & Immunology, Hospital Quironsalud Bizkaia, Bilbao, Spain.
¹⁶ Allergy & Immunology Section, Louisiana State University Health Sciences Center - Shreveport, Louisiana, USA.
¹⁷ Department of Translational Medical Science, University of Naples Federico II, Naples, Italy.
¹⁸ Department of Pediatrics, Section of Pediatric Allergy and Immunology. British Hospital. Buenos Aires, Argentina.
¹⁹ McMaster's University, Hamilton, Ontario, Canada.
²⁰ Paris Descartes University, Pediatric Gastroenterology, Necker Hospital, Paris, Clinique Marcel Sembat, Boulogne-Billancourt, France.
²¹ Clinical Research Center for Allergy and Rheumatology, National Hospital Organization Sagamihara National Hospital, Kanagawa, Japan.
²² Faculty of Medical Sciences of Campina Grande, UNIFACISA University Centre, Campina Grande, Paraiba, Brazil.
²³ Pediatric Allergy Unit, San Pietro Hospital - Fatebenefratelli, Rome, Italy.
²⁴ 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.
²⁵ Evelina London Children's Hospital, Guy's St Thomas' Hospital, NHS Foundation Trust, London, UK.
²⁶ Department of Primary Child Care, Children's Hospital, Chongqing Medical University, China.
²⁷ Allergist, Edmondo de Amicis School, Milan, Italy.
²⁸ Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
²⁹ Allergy Unit, 2nd Paediatric Clinic, University of Athens, Athens, Greece.
³⁰ Allergy & Anaphylaxis Australia (AAA), Castle Hill, New South Wales, Australia.
³¹ Allergy and Clinical Immunology Department, Centro Médico - Docente La Trinidad and Clínica El Avila, Caracas, Venezuela.
³² Cochrane Canada and McMaster University GRADE Center, Hamilton, Ontario, Canada.
³³ 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.
³⁴ Division of Allergy-Immunology, Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine at University of Pennsylvania, Philadelphia, PA, USA.
³⁵ Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
³⁶ Pediatric Primary Care, National Pediatric Health Care System, Milan, Italy.
³⁷ KidZ Health Castle, Department of Pediatrics UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
³⁸ Division of Clinical Immunology and Allergy, Department of Medicine, McMaster University, Hamilton, ON, Canada.
³⁹ Allergy UK, London, England, UK.
⁴⁰ Department of Paediatrics, Faculty of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin, Hong Kong, China.

PMID: 39228431
PMCID: PMC11369454
DOI: 10.1016/j.waojou.2024.100931

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.

Keywords: Baked milk; Cow's milk allergy; Hypoallergenic formulas; Nutrition; Plant based alternatives.

PubMed Disclaimer

Conflict of interest statement

CV reports grants from Reckitt Benckiser, grants from Food Allergy Research and Education, grants from National Peanut Board, during the conduct of the study; and personal fees from Reckitt Benckiser, Nestle Nutrition Institute, Danone, Abbott Nutrition, Else Nutrition, and Before Brands, outside the submitted work. RM reports speaker honoraria and advisory panel consultancy outside of the submitted work for Nutricia/Danone, Abbott Nutrition, Nestle Clinical Nutrition, Reckitt Benckiser and Else Nutrition. MG reports royalties from UpToDate and Academy of Nutrition and Dietetics and consulting fees from FARE. AF reports speaker honoraria and advisory panel consultancy outside the submitted work for Nutricia, Abbott, Danone, Stallergenes, DBV, Novartis; and funded research (Institution) from Sanofi, Novartis, Ferrero, DBV, GSK, Astrazeneca, Hipp GmBDH, Humana SpA.

Figures

**Fig. 1**
**CMA and dietary management tips**. Dietary management of cow's milk allergy involves food elimination, choosing appropriate alternatives, monitoring nutritional intake and status, and taking lifestyle factors into account. (Images were legally obtained through Adobe Stock and should not be extracted for reuse.)

See this image and copyright information in PMC

References

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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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources