Nutritional Management of Cow's Milk Allergy in Infants: A Comparison of DRACMA, ESPGHAN, and AAP Guidelines

Emely L. Barrera1, Carlett Ramirez-Farias2, Barbara J. Marriage2, *
1 Research Park, Abbott Nutrition, University of Illinois at Urbana-Champaign, Champaign, Illinois, USA
2 Scientific and Medical Affairs, Abbott Nutrition, Columbus, Ohio, USA

© 2021 Lopez Barrera et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at Scientific and Medical Affairs, Abbott Nutrition, Columbus, Ohio; Tel: +614-624-4416;


Cow’s Milk Allergy (CMA) is one of the most common food allergies presented during infancy and childhood. The diagnosis and management of CMA is a complex task. First and foremost, CMA is manifested by a variety of symptoms classified by their type of mediation (either IgE and/or non-IgE responses), organ systems involved, and the onset of the reaction. Second, although several guidelines for the management of CMA have been published worldwide, they differ in their recommendations. To our knowledge, no global consensus exists for the management of the different symptoms associated with CMA. This review provides a table to compare three widely accepted published guidelines to enable the reader to easily navigate and compare the nutritional recommendations to be followed depending on the symptomatology. This review is intended to represent a practical tool to assess the nutritional recommendations for the management of CMA.

Keywords: Cow's milk allergy, Food allergy, Guidelines, Nutritional management, Infant formula, DRACMA, ESPGHAN, AAP.