Cockroaches are regarded as important environmental allergens associated with respiratory diseases. The aim of our study was to determine cockroach sensitization patterns in a large number of children, and to document its association with other allergens along with the presence and severity of allergic diseases. Children with various symptoms of suspected atopic diseases such as asthma, allergic rhinitis/conjunctivitis, and atopic dermatitis, with at least 1 positive skin test to a panel of 15 inhalant allergens were included in the study. Blood eosinophil counts and serum total IgE levels were measured, and total atopy index was calculated. A total of 1,513 children were analyzed, and 385 (25.4%) found to have cockroach sensitization. At univariate analyses, asthma, allergic rhinitis, and coexistence of asthma and allergic rhinitis were more frequent in children with cockroach sensitization compared with those without cockroach sensitization (P < 0.05). There was also a novel association between sensitizations of cockroach and pine, aspergillus allergens. However, multivariate analyses revealed a positive association between cockroach sensitization and age at diagnosis, coexistence of asthma and allergic rhinitis, and sensitizations of certain allergens; that is, house dust mite, aspergillus, and pine whereas a negative association for sensitizations of mold mix and weed mix. In a pediatric population with atopic diseases, cockroach sensitization appears to be detected in elder children with coexisting asthma and allergic rhinitis. Presence of house dust mite, pine, and aspergillus sensitizations predict cosensitization of cockroach whereas weed and mold mix sensitizations decrease the possibility of detecting a sensitization.