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Curr Opin Allergy Clin Immunol. 2012 Jun;12(3):316-22. doi: 10.1097/ACI.0b013e3283535bdb.

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

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  • 1Department of Pediatrics, Melloni University Hospital, Milan, Italy. terrycom@hotmail.it



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).


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.


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.

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