Table 1 Reference Guide to the Recommendations [14]
From: DRACMA one year after: Which changes have occurred in diagnosis and treatment of CMA in Italy?
Clinical presentation | 1st choice | 2nd choice | 3rd choice |
|---|---|---|---|
Anaphylaxis | AAF+ | eHF#§ | SF |
Acute urticaria or angioedema | eHF§♠| AAF^/SF° | |
Atopic dermatitis | eHF§♠| AAF^/SF° | |
Immediate gastrointestinal allergy | eHF§♠| AAF^/SF° | |
Allergic eosinophilic oesophagitis | AAF | ||
Gastroesophageal reflux disease (GERD) | eHFâ™ | AAF | |
Cow's milk protein-induced enteropathy | eHF§♠| AAF | |
Food protein-induced enterocolitis syndrome (FPIES) | eHF* | AAF | |
CM protein-induced gastroenteritis and proctocolitis | eHFâ™ | AAF | |
Severe irritability (colic) | eHFâ™ | AAF | |
Constipation | eHFâ™ | AAF | Donkey milk |
Milk-induced chronic pulmonary disease (Heiner's syndrome) ** | AAF^ | eHF | SF |
- + recommendation 7.1
- â™ recommendation 7.2
- * if AAF refusal
- § subject to local availability, HRF can be considered instead than eHF (7.4)
- # subject to a negative SPT with the specific formula (panel recommendation)
- ^AAF if a relatively high value on avoiding sensitization by SF and/or a low value on resource expenditure are placed.
- °SF if a relatively low value on avoiding sensitization by SF and/or a high value on resource expenditure are placed.
- **this suggestion attributes a high value on avoiding exposure to even residual antigenic cow's milk proteins.
based on reports from one case series (chapter 15)- †given that more than 50% of such children are allergic to soy, a careful clinical evaluation is necessary (panel recommendation)