Department of Child and Maternal Medicine, Melloni Hospital, Milan, Italy.
J Allergy Clin Immunol. 2010 Dec;126(6):1119-28.e12. doi: 10.1016/j.jaci.2010.10.011.
The 2nd Milan Meeting on Adverse Reactions to Bovine Proteins was the venue for the presentation of the first consensus-based approach to the management of cow's milk allergy. It was also the first time that the Grading of Recommendations, Assessments, Development, and Evaluation approach for formulating guidelines and recommendations was applied to the field of food allergy. In this report we present the contributions in allergen science, epidemiology, natural history, evidence-based diagnosis, and therapy synthesized in the World Allergy Organization Diagnosis and Rationale for Action against Cow's Milk Allergy guidelines and presented during the meeting. A consensus emerged between discussants that cow's milk allergy management should reflect not only basic research but also a newer and better appraisal of the literature in the light of the values and preferences shared by patients and their caregivers in partnership. In the field of diagnosis, atopy patch testing and microarray technology have not yet evolved for use outside the research setting. With foreseeable breakthroughs (eg, immunotherapy and molecular diagnosis) in the offing, the step ahead in leadership can only stem from a worldwide organization implementing consensus-based clinical practice guidelines to diffuse and share clinical knowledge.
第二届米兰牛乳蛋白不良反应会议提出了首个基于共识的牛乳过敏管理方法。这也是首次将制定指南和推荐的建议分级、评估、制定和评价方法应用于食物过敏领域。在本报告中，我们介绍了在变应原科学、流行病学、自然史、循证诊断和治疗领域的贡献，这些贡献综合在世界过敏组织牛乳过敏诊断和治疗建议中，并在会议上进行了介绍。与会者达成了共识，即牛乳过敏管理不仅应反映基础研究，还应根据患者及其照护者的价值观和偏好，对文献进行更好的评估。在诊断领域，变应原斑贴试验和微阵列技术尚未在研究环境之外得到应用。随着预期的突破（如免疫治疗和分子诊断）的出现，领导的下一步只能来自于一个实施基于共识的临床实践指南的全球性组织，以传播和分享临床知识。
