OBJECTIVES: To examine patterns and economic outcomes of allergy immunotherapy (IT) care among children with allergic rhinitis (AR). METHODS: We examined the 1997-2004 Florida Medicaid dataset to identify children (<18 years) who received an AR diagnosis and IT. Those receiving IT who were continuously enrolled and had data ³4 years following and ³1 year prior to initial AR diagnosis were included in clinical and economic subanalyses. RESULTS: There were 104,963 children diagnosed with AR; 5,532 (5.3%) received IT. Mean age at IT initiation was 8.2 years (SD 3.5). Compared to those with AR who did not receive IT, children who received IT were significantly older (mean age 7.7 versus 7.0, SD 3.6, p=0.001). Significantly less patients receiving IT were female or Caucasian (p =0.001). The average number of IT administrations was 22 (SD 27.0); approximately half of patients (45.2%) received less than 10 IT administrations. Average treatment duration was 1 year (SD 15.8 months); more than half (51.2%) of patients received IT for less than 6 months, and only 1 in 12 patients (8.7%) completed the Guideline-recommended minimum 3-year course of therapy. Among the 308 patients receiving IT who were included in clinical and economic subanalyses, average IT cost was $20 (SD $23) per administration and $468 (SD $543) over the treatment course. Pharmacy, outpatient and inpatient costs significantly decreased in the 6 months following completion of IT versus the 6 months prior to IT initiation (-$78, p=0.0125; -$273, p= 0.0005; - $2,123, p=0.0092 respectively). CONCLUSION: We found wide variation in IT delivery by sex and race. Despite the preponderance of premature IT discontinuation among patients in our study, significant cost savings were demonstrated. Findings suggest that patients with AR and the healthcare systems that provide care to these patients may benefit from broader access and improved adherence to IT.