Background: Allergic rhinitis (AR) is a common immunoglobulin E (IgE)-mediated disorder of the nasal mucosa. Accurate identification of the offending aeroallergens is pivotal for targeted management. Skin Prick Testing (SPT) has long been the gold standard, yet serum-based Enzyme-Linked Immunosorbent Assay (ELISA) for specific IgE offers a viable, less invasive alternative. The comparative effectiveness of these two methods for aeroallergen detection in AR remains a subject of ongoing investigation. Methods: A cross-sectional study was performed in 200 adult patients (18–65 years) clinically diagnosed with AR. All participants underwent SPT with a standardized panel of common aeroallergens, followed by measurement of serum-specific IgE levels against the same allergens using ELISA. Sensitivity, specificity, and concordance (Cohen’s kappa) were analyzed. Statistical significance was set at p<0.05. Results: Dust mites and pollens were identified as the most frequent aeroallergens. SPT demonstrated slightly higher sensitivity (86–95%) than ELISA (80–90%) for various allergens. Specificities for both methods were similarly high (SPT: 88–96%; ELISA: 85–93%). Concordance between SPT and ELISA was substantial (κ=0.78, p<0.001). Patients generally tolerated both tests well, with minor local skin reactions reported in SPT and minimal bruising following venipuncture for ELISA. Conclusion: SPT remains highly effective for aeroallergen identification in AR, with a marginally higher sensitivity than ELISA. Serum-specific IgE testing (ELISA) provides a practical alternative, especially for patients with contraindications to SPT. Given their substantial agreement, these methods can be used complementarily or interchangeably in routine clinical practice to guide allergen avoidance measures and immunotherapy strategies, ultimately improving patient outcomes.