Table 3: CMA nutritional management (EHF, AAF, SF, and RHF): Comparative table of DRACMA, ESPGHAN and AAP guidelines.

Clinical Presentations DRACMA14,25 ESPGHAN13 AAP24
Option 1 Option 2 Option 1 Option 2 Option 1 Option 2
Anaphylaxis AAF EHF / RHFb AAF -- EHFf/ SFa Documented reactions to SF have been extremely rare AAF
Immediate Gastrointestinal Allergy (IGA) EHF/RHF b AAF EHFf  AAF
in<6 mo of age
SFd in
> 6 mo of age
RHFd 		EHFf/ SFa AAF
Atopic Dermatitis (atopic eczema) EHF / RHFb AAFc /SFa EHFf
 		 AAF
in<6 mo of age
SFd 
in > 6 mo of age
RHFd 		EHFf AAF
FPIES / severe enteropathy indicated by hypoproteinemia and failure to thrive  AAFe EHF
If infant/child refuses AAF 		AAFe -- EHFef AAF
Allergic eosinophilic esophagitis (EoE) AAF -- AAF -- EHFf AAF
Respiratory Symptoms (e.g., Rhinitis and Asthma)  EHF / RHFb AAFc /SFa EHFf AAF /RHFd EHFf/ SF AAF
Skin Symptoms (e.g., Acute urticaria, Angioedema) EHF / RHFb AAFc /SFa EHFf   AAF
in<6 mo of age
SFd 
in > 6 mo of age
RHFd 		EHFf/ SF AAF
Gastrointestinal Symptoms (e.g., Constipation, GERD, Severe irritability (la) EHF AAF EHFf   AAF
in <6 mo of age
SFd  
in > 6 mo of age
RHFd 		EHFf AAF
Food protein-induced enteropathy (FPE) EHF / RHFb AAF EHFf   AAF
in<6 mo of age
SFd
in > 6 mo of age
RHFd 		EHFf AAF

a. Only in infants > 6 mo of age
b. When available, RHF can substitute for EHF and become 1st option for nutritional management 
c. If the infant/child is at-risk of sensitization to soy proteins and caregivers can afford, AAF will be recommended instead of SF
d. May be considered in selected infants refusing or not tolerating EHF, if EHF or AAF are too expensive for caregivers, or parents with strong preferences (e.g., vegan families) ​
e. The most recent FPIES guidelines recommend both EHF and AAF for the nutritional management of FPIES 27
f. The guideline is not specific, but EHF is generally recommended as the first line of treatment.