The sIgE test kit in this study was also used in previous studies which have been published (26,27). buttermilk sIgE-positive, and 158 were only raw milk sIgE-positive. The boiled milk-positive group had the highest levels of raw milk sIgE and casein sIgE antibodies, followed sequentially by the yogurt-positive, GNA002 buttermilk-positive, and raw milk-positive groups. The boiled milk group observed the highest levels of sIgE against raw milk, casein, -lactalbumin, and -lactoglobulin. These levels differed significantly from those in the other three groups. Allergic symptoms were distributed differently among the four study groups. The percentages of allergic patients with gastrointestinal tract symptoms in the above mentioned four groups ranged from high to low, and the percentages of patients with skin symptoms in the four groups ranged from low to high, respectively. == Conclusion == Based on dairy product sIgE antibody levels associated with different milk components and various clinical allergic symptom tendencies, we could distinguish four CMPA phenotypes. Keywords:cows milk allergy, IgE, Fermented milk, boiled milk, raw milk == Introduction == GNA002 Food allergies are a health problem of increasing concern worldwide. Food allergy is defined as a specific immune response caused by a portion of specific food, which can occur repeatedly Bmp1 and cause disorders involving the skin or gastrointestinal or respiratory tract. Milk, eggs, wheat, soybeans, peanuts, nuts, fish, and shellfish are considered to be the common causes of food allergy (1). Cows milk protein allergy (CMPA) is a specific immune response to various proteins in milk. GNA002 CMPA can be attributed to immunoglobulin E (IgE)-mediated and non-IgE-mediated mechanisms (28). CMPA is the most common food protein allergy in infants and children (9). In previous studies, the prevalence of IgE-mediated CMPA was 2%-9% (9). A prospective study of 6768 children with suspected CMPA conducted jointly by seven hospitals in southern China showed that 182 children were diagnosed with CMPA, and the prevalence of CMPA was 2.69% (10). A food allergy may endanger life safety and greatly affect quality of life. An accurate food allergy diagnosis is necessary to avoid severe allergic reactions and unnecessary dietary restrictions. However, accurate diagnosis can be difficult. According to practice guidelines (11), the initial diagnosis of CMPA should be based on the exclusion of milk protein from the diet. Then, a double-blind placebo-controlled oral food challenge (OFC), the gold standard for the diagnosis of CMPA (3,12), should be performed. However, the trial requires the cooperation of patients and parents, which is time-consuming and expensive. It is challenging to implement under real-world conditions GNA002 in China. Even nondouble-blind OFC has the risk of an immediate or severe allergic reaction (13). There are diagnostic methods for diagnosing CMPA other than OFC, including screening scoring systems, skin prick tests (SPTs) and serum milk-specific Immunoglobulin E (sIgE) detection. However, the cutoff point value of the milk-related symptom score has not been agreed upon in the academic community, and the sensitivity and specificity of this diagnostic tool are low (14). The area under the receiver operating characteristic (ROC) curve (AUC) was only 0.68 (14). An SPT is used to detect the presence of IgE tissue-binding antibodies, which can reflect IgE-mediated allergic diseases to a certain extent. However, this test is prone to false-negative results in infants because infants usually have a poor response to the SPT (15). Because of the convenience and ability to detect various allergens, serum sIgE detection (1620) is widely used to assist in the diagnosis of GNA002 CMPA in China. CMPA patients need to strictly avoid milk in daily life to prevent the occurrence of an allergic reaction. However, this common management practice has coincided with the delayed resolution of the allergy. Strict milk avoidance does not improve long-term outcomes and significantly affects patients quality of life. Many CMPA patients.