BACKGROUND The aim of the study was to evaluate the usefulness of skin prick tests and serum allergen-specific IgE determination in diagnosis of occupational airway allergies. METHODS The study group comprised 152 patients with suspected occupational asthma and occupational allergic rhinitis. In all subjects, skin prick tests (SPT) to occupational allergens and specific challenge test were performed, and serum allergen-specific IgE (as-IgE) was determined. The sensitivity, specificity and predictive values of SPT and serum as-IgE were evaluated for different types of allergens (flour, grain, natural rubber latex and cotton). RESULTS SPT sensitivity ranged from 22.2 to 68.2%, and specificity from 74.1 to 88.2%, depending on the allergen. Positive predictive values for SPT ranged from 30 to 68.2% and negative predictive values from 74 to 82.4%. As-IgE sensitivity was evaluated from 42.8 to 83.3%, and specificity from 57.1 to 81.5%. Positive predictive values for as-IgE ranged from 35.7 to 76.2% and negative predictive values from 72.4 to 92.3%. CONCLUSIONS The results showed that neither SPT nor serum as-IgE determination indicated sufficient sensitivity and specificity to play a key role in diagnosis of occupational asthma and rhinitis. The sensitivity, specificity and predictive values varied depending on the type of allergen. During the diagnostic process of occupational asthma and rhinitis the specific inhalant challenge test should be taken into consideration to confirm the final diagnosis.