Effectiveness of virtual reality in reducing anxiety, fear, and pain in children undergoing skin prick testing: A crossover study

Background: Skin prick testing (SPT) is a cornerstone diagnostic procedure for identifying allergic sensitizations in children. Despite being minimally invasive, it often provokes considerable anxiety, fear, and pain, potentially compromising test accuracy due to poor compliance. Virtual reality (VR) has emerged as a promising non-pharmacological tool for procedural distress management, yet its application in allergy diagnostics remains underexplored. Objective: To evaluate the effectiveness of VR in reducing procedural anxiety, fear, and pain, and improving compliance in children undergoing SPT. Methods: This single-center, cross-over interventional study enrolled 108 children (aged 4-18 years) with suspected or confirmed environmental or food allergies. Each participant underwent two SPT sessions: one with immersive VR distraction and one using standard-of-care (SOC) distraction methods, separated by a 6-month washout period. Outcomes were assessed using validated scales for anxiety (Children's Anxiety Meter), fear (Children's Fear Scale), pain (Wong-Baker FACES), and procedural compliance (modified Induction Compliance Checklist). Physiological parameters and staff satisfaction were also recorded. Results: VR significantly reduced anxiety, fear, and pain compared to SOC across multiple time points, with marked improvements in compliance (100% full compliance in the VR group vs. 0% in SOC) and staff satisfaction. No adverse events were reported, confirming the safety of VR in this setting. Conclusions: VR is a safe and effective tool for minimizing procedural distress and enhancing compliance in children undergoing SPT. Its integration into routine allergy diagnostics may improve patient experience and procedural success.