Background Recent studies suggest that sensitization to cockroach allergens is common in urban areas and highlight the importance of cockroach allergens as a risk factor for asthma. Objective To elucidate the prevalence of cockroach allergy in atopic Italian children and to evaluate the correlation between cockroach allergens and other major indoor allergens. Methods Four hundred eighty two children with at least one positive skin test response to a common allergen and with personal history of atopic diseases, were investigated. A questionnaire was administered in order to obtain data on epidemiologic and clinical characteristics of the population. Skin tests to 24 common allergens (including extracts of two cockroach species) were carried out and serum total and cockroach specific IgE were evaluated. Results 61/482 (12.7%) children had positive skin test to cockroach extracts. Among them the frequency of children living in urban areas was higher ( P < .05). In addition, a significant correlation between results of skin tests to cockroach and mite allergens was observed ( P < .009). No correlation between cockroach allergy and the clinical characteristics of the study population was found. Conclusions The results show that cockroach allergy affects a small portion of atopic Italian children and suggest that it is related with living in urban areas and with sensitization to other indoor allergens, such as dust mite.