Cockroach allergen is a well-recognized trigger for asthma and allergic rhinitis, but the clinical significance of isolated cockroach sensitization remains poorly understood. Sensitization does not always equate to clinically relevant allergy. Objective: To assess the prevalence, clinical profile, co-sensitization patterns, pseudopod behaviour, and statistical associations related to cockroach sensitization among young adults undergoing skin prick testing (SPT) in a tertiary centre. METHODS: A cross-sectional analysis of 97 valid SPTs performed at AIMSR, Hyderabad. Participants were categorized into: (1) Isolated cockroach sensitization, (2) Cockroach + other allergens, (3) Non-cockroach sensitizations. Clinical characteristics were extracted from standardized questionnaires. Sensitization associations were analysed using Fisher’s exact test and odds ratios. Results: Cockroach sensitization was observed in 40.2% (39/97). Only 20.5% (8/39) exhibited isolated cockroach sensitization, most of whom were asymptomatic. In contrast, polysensitized subjects (n=31) demonstrated high rates of persistent rhinitis, wheeze/asthma, skin symptoms, and strong family history. Cockroach-specific pseudopods occurred in 64.1% of sensitized participants. The only statistically significant co-sensitization was with Dermatophagoides pteronyssinus (Dp) (OR=2.7, p=0.04). Chenopodium and Ricinus showed borderline trends. No systemic reactions occurred. Conclusion: Isolated cockroach sensitization represents silent IgE positivity without clinical disease in most cases, whereas cockroach sensitization within a polysensitized profile identifies a high-risk atopic phenotype. Cockroach SPT positivity must be interpreted with careful clinical correlation.