Dahdah Lamia, Arasi Stefania, Valluzzi Rocco Luigi, Fierro Vincenzo, Fiocchi Alessandro
Division of Allergy, University Department of Pediatrics, Pediatric Hospital Bambino Gesù, Rome, Vatican City.
Curr Opin Allergy Clin Immunol. 2019 Apr;19(2):185-191. doi: 10.1097/ACI.0000000000000513.
Allergic diseases are increasing worldwide and are considered an important public health problem causing severe and even life-threatening reactions. The creation of guidelines aims to help clinicians improving the quality of diagnosis and management of such diseases. Clinical practice guidelines alone are not sufficient and there is a need for implementation strategies for their introduction into daily practice. We report here the main international allergy guidelines with a more focused look on the Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines and their effect on clinical practice.
DRACMA guidelines have clearly modified the approach to cow's milk allergy (CMA) from its diagnosis to treatment tailoring the choices for each patient. Although they strongly recommend oral food challenge for diagnosing CMA, they also indicate that it may not be necessary in many cases with the introduction of the pretest probability of CMA. Studies on the implementation of DRACMA guidelines show how they influenced the formula market, making appropriate treatments more affordable.
DRACMA reconciled international differences in the diagnosis and management of CMA. They introduced the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology in the field of food allergy and highlighted the importance for meta-analyses to be able to adapt recommendations to the local context.
过敏性疾病在全球范围内呈上升趋势，被视为一个重要的公共卫生问题，可引发严重甚至危及生命的反应。制定指南旨在帮助临床医生提高此类疾病的诊断和管理质量。仅靠临床实践指南是不够的，还需要将其引入日常实践的实施策略。我们在此报告主要的国际过敏指南，并更聚焦于牛奶过敏诊断与行动依据（DRACMA）指南及其对临床实践的影响。
DRACMA指南显著改变了牛奶过敏（CMA）从诊断到治疗的方法，为每个患者量身定制选择。尽管它们强烈推荐口服食物激发试验用于诊断CMA，但也指出随着CMA预测试概率的引入，在许多情况下可能并非必要。关于DRACMA指南实施情况的研究表明了它们如何影响配方奶粉市场，使合适的治疗方法更具可及性。
DRACMA协调了CMA诊断和管理方面的国际差异。它们在食物过敏领域引入了推荐分级评估、制定和评价（GRADE）方法，并强调了荟萃分析能够使推荐适应当地情况的重要性。
