Background: The role of Component Resolved Diagnostics (CRD) in the diagnosis of cow’s milk allergy (CMA) remains highly controversial. In this systematic review, we aimed to evaluate the accuracy of CRD in diagnosing CMA in children. Methods: We searched four electronic databases (EMBASE, PubMed, the Cochrane Library, and Web of Science) from January 1, 2000, to March 27, 2023, for studies that utilized milk composition and oral food challenges (OFC) as a reference standard in patients with suspected milk allergy. The quality of the included studies was assessed using QUADAS-2. Due to the heterogeneity of the studies, a meta-analysis could not be performed, and a narrative synthesis of the findings was conducted. Results: Our analysis included 5 prospective studies, 2 retrospective studies, and 2 case-control studies, with a total of 958 children. The sensitivity of Bos d 4 ranged from 0.50 to 0.82, and specificity from 0.78 to 0.98. Bos d 5 sensitivity 0.24-1.0, and specificity 0.58-0.98. Bos d 6 sensitivity 0.09, and specificity 0.94. Bos d 8 sensitivity 0.34-0.90, specificity 0.79-0.98. CONCLUSION: The specific IgE (sIgE) of the Bos d 4, Bos d 6, and Bos d 8 components of milk is highly specific but not sensitive in diagnosing cow’s milk allergy in children. The use of CRD for the diagnosis of CMA in children may reduce the need for OFC.