Table 1.

Summary of the recommendations

Question 1: Should oral immunotherapy with unheated cow's milk, rather than no immunotherapy, be used in persons with IgE-mediated CMA?
Recommendation 1A:
We suggest oral immunotherapy with unheated cow's milk, rather than no immunotherapy, for those people with IgE-mediated CMA who place a higher value on being able to consume milk (even if in small amounts) with less need to follow a strict avoidance diet, and a lower value on allergic reactions during oral immunotherapy.
(CONDITIONAL recommendation based on a moderate certainty evidence about health effects)
Recommendation 1B:
We suggest that clinicians do not use oral immunotherapy with cow's milk in those people with IgE-mediated CMA who place a higher value on avoiding allergic reactions during oral immunotherapy, and a lower value on being able to consume cow's milk (even if in small amounts) with less need to follow a strict avoidance diet.
(CONDITIONAL recommendation based on a moderate certainty evidence about health effects)
Question 2: Should omalizumab, rather than no anti-IgE therapy, be used during oral immunotherapy with unheated cow's milk in persons with IgE-mediated CMA?
Recommendation 2:
We suggest that clinicians use omalizumab, compared with not using it, during the initial stages of oral immunotherapy with unheated cow's milk in people with IgE-mediated CMA.
(CONDITIONAL recommendation based on a very low certainty evidence about health effects)
Question 3: Should oral immunotherapy with baked cow's milk, rather than no immunotherapy, be used for persons with IgE-mediated CMA who do not tolerate baked cow's milk?
Recommendation 3:
In people with IgE-mediated CMA who do not tolerate unheated and baked milk, we suggest that clinicians do not use oral immunotherapy with baked cow's milk.
(CONDITIONAL recommendation based on a very low certainty evidence about health effects)
Remark: This recommendation concerns persons who react to very small doses of baked milk. Persons with IgE-mediated CMA who do tolerate certain amounts of baked cow's milk can continue consuming it and advance with the amounts tolerated under physician supervision.
Question 4: Should epicutaneous immunotherapy with cow's milk, rather than no immunotherapy, be used for persons with IgE-mediated CMA?
Recommendation 4:
More rigorously designed and performed studies of epicutaneous immunotherapy for IgE-mediated CMA are needed to make a recommendation for clinical practice. Thus, we recommend that, for now, clinicians do not use epicutaneous immunotherapy for IgE-mediated CMA outside of the research setting.
(STRONG recommendation based on a very low certainty evidence about health effects)