Pediatric allergic diseases are a growing global public health concern due to their increasing prevalence and impact on children’s quality of life. In Tunisia, the incidence of these conditions has risen markedly, with evolving clinical and allergenic patterns over time.

This study aims to describe the epidemiological evolution of clinical and allergenic profiles in atopic children in Tunisia over a 30-year period.

We conducted a retrospective study of children aged 1–16 years who were referred for allergic manifestations to the allergy clinic of the Internal Security Forces Hospital (FSI), La Marsa, and underwent skin prick testing (SPT) between 1992 and 2022. Trends were compared across three decades (D1:1992–2001, D2: 2002–2011, and D3:2012–2022) for the entire cohort and within three age groups (preschool, school-aged, and adolescents.

A total of 4313 children were included (mean age: 7.7 ± 3.5 years; sex ratio: 1.39). A family history of atopy was reported in 58.9 % of cases. Rhinitis (76.4 %) and asthma (63.9 %) were the most common presentations. Multiple allergic manifestations were more frequent than isolated ones (58.8 % vs. 41.1 %). SPTs were positive in 57.4 % of cases; dust mites were the most frequent allergen (66.6 %), followed by animal dander and pollens. Polysensitization was observed in 49.7 % of children, most frequently involving dust mites in combination with other allergens. Over the three decades, there was a marked increase in the prevalence of multiple allergic manifestations (from 51.4 % in D1 to 68.5 % in D3; p < 0.001) and polysensitization among sensitized children (from 35.5 % in D1 to 61.1 % in D3; p < 0.001). The age-stratified analysis revealed that this trend towards complexity begins in early childhood, with the rate of polysensitization in preschoolers (1–5 years) soaring from 27.0 % to 62.0 % ( p < 0.001). In adolescents (≥12 years), asthma prevalence remained stable ( p = 0.124), while rhinitis, rhinoconjunctivitis, and polysensitization continued to increase significantly.

This study highlights significant changes towards greater frequency and complexity of pediatric allergic diseases over the past 30 years, characterized by a rise in multiple manifestations and polysensitization. These trends, particularly pronounced in preschoolers, suggest an accelerated allergic march, warranting adapted clinical and public health strategies.