Summary To date, several aspects of allergic rhinitis remain controversial. In particular, data concerning its epidemiological evolution are extremely contradictory and vary between negation and assertion of an increased prevalence within the last decade. In the study discussed in this paper, our aim was to follow the evolution of allergic rhinitis in three different territorial areas of Central Italy in the last 20 years and to analyse the long‐term efficacy of treatment. Between 1980 and 1981, 1620 children, attending seven state schools (four elementary and three lower secondary), were screened for allergic rhinitis. All children underwent a skin test on the inner forearm. Positive‐skin‐test children were examined to specify the exact nasal allergy. Between 1998 and 1999, positive‐skin‐test patients were contacted and re‐examined. The results revealed that elementary school children showed lower degrees of skin positivity, a better nasal patency, a more efficient nasal clearance and less frequent anomalous radiological findings. Seventy‐three children were positive to skin tests (4.5%). Forty‐six positive‐skin‐test subjects were re‐examined: 21 recovered, 12 were unchanged, 10 developed complications, three become asthmatics. Twenty‐one subjects had not received any treatment, 15 were treated with symptomatic drugs, and 10 with immunotherapy. Our study showed an increased prevalence of allergic rhinitis in the last 20 years of the 20th century, with a jump from 4.5 to 10–20%; moreover, it showed that immunotherapy guarantees remission of local symptoms and valid protection against localized and bronchial complications. Symptomatic treatment with antihistamines and/or corticosteroids, although not always resolutive, represents a valid alternative.