The World Allergy Organization (WAO) has updated its Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines to provide evidence-based recommendations for the use of specialized milk formulas, with and without probiotics, for infants and toddlers with cow's milk allergy (CMA). The guidelines aim to support patients, clinicians, and others in making informed decisions about dietary management. **Background:** CMA is the most common food allergy in infants, affecting 1-7.5% of infants. Specialized formulas, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF), and soy formulas (SF), are used to ensure adequate growth and minimize severe allergic reactions when breastfeeding is not possible. However, the choice of formula can be complex due to the availability of multiple options. **Methods:** The WAO formed a multidisciplinary guideline panel to develop these guidelines, using the GRADE approach to assess the certainty of evidence and prioritize clinical questions. The panel considered various outcomes, including acquisition of cow's milk tolerance, failure to thrive, epinephrine use, vomiting, diarrhea, and wheezing. **Results:** The guidelines suggest: 1. For infants with IgE-mediated CMA who are not being breastfed, eHF-CM or HRF should be the first option, followed by AAF and SF. 2. For infants with non-IgE-mediated CMA who are not being breastfed, eHF-CM or HRF should be the first option, followed by AAF and SF. 3. For infants with IgE-mediated CMA, either a formula without probiotics or an eHF-CM containing *Lacticaseibacillus rhamnosus* (LGG) can be used. **Conclusions:** Clinicians, patients, and caregivers should discuss all potential benefits and drawbacks of different formulas, considering individual patient factors, local availability, and cost. The guidelines also highlight the need for further research to determine the most beneficial, cost-effective, and equitable formulas. **Keywords:** Milk allergy, Milk replacement formulas, Probiotics, Clinical practice guidelines, GRADE **Summary of Recommendations:** - For IgE-mediated CMA: eHF-CM or HRF as first option, AAF as second, SF as third. - For non-IgE-mediated CMA: eHF-CM or HRF as first option, AAF as second, SF as third. - For IgE-mediated CMA: formula without probiotics or eHF-CM with LGG. - Conditional recommendations due to very low certainty evidence about health effects.The World Allergy Organization (WAO) has updated its Diagnosis and Rationale for Action against Cow's Milk Allergy (DRACMA) guidelines to provide evidence-based recommendations for the use of specialized milk formulas, with and without probiotics, for infants and toddlers with cow's milk allergy (CMA). The guidelines aim to support patients, clinicians, and others in making informed decisions about dietary management. **Background:** CMA is the most common food allergy in infants, affecting 1-7.5% of infants. Specialized formulas, such as extensively hydrolyzed cow's milk protein formula (eHF-CM), amino acid formula (AAF), hydrolyzed rice formula (HRF), and soy formulas (SF), are used to ensure adequate growth and minimize severe allergic reactions when breastfeeding is not possible. However, the choice of formula can be complex due to the availability of multiple options. **Methods:** The WAO formed a multidisciplinary guideline panel to develop these guidelines, using the GRADE approach to assess the certainty of evidence and prioritize clinical questions. The panel considered various outcomes, including acquisition of cow's milk tolerance, failure to thrive, epinephrine use, vomiting, diarrhea, and wheezing. **Results:** The guidelines suggest: 1. For infants with IgE-mediated CMA who are not being breastfed, eHF-CM or HRF should be the first option, followed by AAF and SF. 2. For infants with non-IgE-mediated CMA who are not being breastfed, eHF-CM or HRF should be the first option, followed by AAF and SF. 3. For infants with IgE-mediated CMA, either a formula without probiotics or an eHF-CM containing *Lacticaseibacillus rhamnosus* (LGG) can be used. **Conclusions:** Clinicians, patients, and caregivers should discuss all potential benefits and drawbacks of different formulas, considering individual patient factors, local availability, and cost. The guidelines also highlight the need for further research to determine the most beneficial, cost-effective, and equitable formulas. **Keywords:** Milk allergy, Milk replacement formulas, Probiotics, Clinical practice guidelines, GRADE **Summary of Recommendations:** - For IgE-mediated CMA: eHF-CM or HRF as first option, AAF as second, SF as third. - For non-IgE-mediated CMA: eHF-CM or HRF as first option, AAF as second, SF as third. - For IgE-mediated CMA: formula without probiotics or eHF-CM with LGG. - Conditional recommendations due to very low certainty evidence about health effects.