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WAO Special Committee on Food Allergy

The WAO Food Allergy Special Committee is in the process of developing an evidence-based document:

Cow's Milk Allergy (CMA) in infancy and childhood: from suspicion to treatment

Why this document and why now?
A new CMA Document is necessary because:

  • The current documents on CMA treatment are not global in scope
  • The existing documents are not up-to-date
  • Much of the existing research is not evidence-based

Format & Methodology:
This will be an evidence-based document using GRADE methodology. The authors of the document are supported by the WAO Evidence Based Medicine Special Committee. The GRADE methodology ensures the best grading of evidence and formulation of recommendations, based on existing literature. Upon completion, this document will be referred to as the Diagnosis & Rationale for Action against Cow's Milk Allergy (DRACMA) Guidelines

Target audience

  • Allergists, both pediatric and adult
  • Gastroenterologists
  • General practitioners
  • Dermatologists
  • Dieticians
  • Specialist nurses (Food Allergy)


  1. CMA epidemiology
  2. Clinical suspicion (history and symptoms)
  3. Mechanisms of CMA and clinical spectrum (IgE- and non-IgE-mediated symptoms)
  4. Diagnostic step 1: elimination diet
  5. Diagnostic step 2: skin prick-puncture testing (SPT)
  6. Diagnostic step 3: specific IgE (spIgE) determinations
  7. Diagnostic step 4: patch test
  8. Diagnostic step 5: novel technologies
  9. Diagnostic step 6: non-conventional tests
  10. Diagnostic step 7: Oral Food Challenge (open, single blinded)
  11. Diagnostic step 8: Double-blind placebo-controlled challenge (DBPCFC)
  12. Natural history
  13. Choosing the right alternative for CMA: relevant questions
    • Is it tolerated by children?
    • What percentage of children reacts to the first dose?
    • What percentage of children has a delayed onset reaction?
    • Is it nutritionally adequate?
    • Is it cost-effective?
    • Is it palatable?
    • Has it been studied in children with multiple food allergies?
  14. What is the first formula choice?
  15. Switching the child to a different formula when the first choice formula fails
  16. Is it possible to alter the natural history of CMA?
  17. Specific Oral Tolerance Induction (SOTI) issues

Creating consensus through

  1. Literature review
  2. Rating evidence and strength levels using GRADE methodology.
  3. Discussions – email, conference calls
  4. Meetings during international events
  5. Presentation to the WAO Board of Directors
  6. Endorsements
  7. Public presentations
  8. Publications

Time line

  • Completion of document: December 2009
  • Public presentation of document: February 2010 in Milan, Italy (
  • Publication of document: 2010


The document is being supported through an unrestricted educational grant from the following organizations:

Heinz Ordesa

Also supported in part by:

Nestle Nutrition