@article{3219168,
    title = "World Allergy Organization (WAO) Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) Guideline update – XIV – Recommendations on CMA immunotherapy",
    author = "Brozek, J.L. and Firmino, R.T. and Bognanni, A. and Arasi, S. and Ansotegui, I. and Assa'ad, A.H. and Bahna, S.L. and Canani, R.B. and Bozzola, M. and Chu, D.K. and Dahdah, L. and Dupont, C. and Dziechciarz, P. and Ebisawa, M. and Galli, E. and Horvath, A. and Kamenwa, R. and Lack, G. and Li, H. and Martelli, A. and Nowak-Węgrzyn, A. and Papadopoulos, N.G. and Pawankar, R. and Roldan, Y. and Said, M. and Sánchez-Borges, M. and Shamir, R. and Spergel, J.M. and Szajewska, H. and Terracciano, L. and Vandenplas, Y. and Venter, C. and Waffenschmidt, S. and Waserman, S. and Warner, A. and Wong, G.W.K. and Fiocchi, A. and Schünemann, H.J.",
    journal = "World Allergy Organization Journal",
    year = "2022",
    volume = "15",
    number = "4",
    publisher = "HANLEY & BELFUS-ELSEVIER INC",
    issn = "1939-4551",
    doi = "10.1016/j.waojou.2022.100646",
    keywords = "epinephrine;  omalizumab, anaphylaxis;  Article;  clinician;  cow milk;  dairy product;  drug effect;  eosinophilic esophagitis;  epicutaneous immunotherapy;  evidence based medicine;  family;  gastrointestinal disease;  health care cost;  human;  immunotherapy;  medical decision making;  medical society;  milk allergy;  oral immunotherapy;  patient attitude;  patient compliance;  practice guideline;  respiratory tract disease;  risk benefit analysis;  stakeholder engagement;  treatment outcome",
    abstract = "Background: The prevalence of cow's milk allergy (CMA) is approximately 2–4.5% in infants and less than 0.5% in adults. Most children outgrow cow's milk allergy in early childhood, particularly that to the baked milk products. Immunotherapy with unheated cow's milk has been used as a treatment option for those who have not yet outgrown CMA, but the benefits must be balanced with the adverse effects. Objective: These evidence-based guidelines from the World Allergy Organization (WAO) intend to support patients, clinicians, and others in decisions about the use of oral and epicutaneous immunotherapy for the treatment of IgE-mediated CMA. Methods: WAO formed a multidisciplinary guideline panel balanced to include the views of all stakeholders and to minimize potential biases from competing interests. The McMaster University GRADE Centre supported the guideline-development process, including updating or performing systematic evidence reviews. The panel prioritized clinical questions and outcomes according to their importance for clinicians and patients. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used, including GRADE Evidence-to-Decision frameworks, which were subject to public comment. Results: After a careful review of the summarized evidence and thorough discussions the WAO guideline panel suggests: a) using oral immunotherapy with unheated cow's milk in those individuals with confirmed IgE-mediated CMA who value the ability to consume controlled quantities of milk more than avoiding the large adverse effects of therapy, b) not using oral immunotherapy with unheated cow's milk in those who value avoiding large adverse effects of therapy more than the ability to consume controlled quantities of milk, c) using omalizumab in those starting oral immunotherapy with unheated cow's milk, d) not using oral immunotherapy with baked cow's milk in those who do not tolerate both unheated and baked milk, and e) not using epicutaneous immunotherapy outside of a research setting. The recommendations are labeled “conditional” due to the low certainty about the health effects based on the available evidence. Conclusions: Clinicians, patients, and their family members might want to discuss all the potential desirable and undesirable effects of oral immunotherapy for IgE-mediated CMA and integrate them with the patients' values and preferences before deciding on a treatment option. More robust research is needed to determine with greater certainty which interventions are likely to be the most beneficial with the least harms, and to develop safer, low-cost, and equitable treatments. © 2022 The Authors"
}