<p>Skin prick testing (SPT), although minimally invasive, is frequently associated with procedural pain, fear, and anxiety in pediatric populations. This randomized controlled trial aimed to compare the effectiveness of immersive virtual reality (VR) and the Buzzy® device in reducing procedural distress during SPT.&#xa0;In this randomized pretest–posttest study, 90 children aged 7–10&#xa0;years undergoing first-time SPT at a Turkish university hospital were randomly allocated to VR distraction (<i>n</i> = 30), Buzzy® (<i>n</i> = 30), or routine care (<i>n</i> = 30). Pain, fear, and state anxiety were assessed before and after the procedure using validated pediatric scales reported by children, parents, and researchers. Group differences were analyzed using one-way ANOVA and chi-square tests. A mixed-design ANOVA examined group-time effects with Bonferroni-adjusted comparisons. Statistical significance was set at <i>p</i> &lt; .05. Groups were comparable at baseline (<i>p</i> &gt; .05). Significant group-time effects were identified for pain (F: 27.06, <i>p</i> &lt; .001, pη²: .38), fear (F: 33.14, <i>p</i> &lt; .001, pη²: .43), and anxiety (F: 44.76, <i>p</i> &lt; .001, pη²: .51). Post-procedure scores were lowest in the VR group, followed by Buzzy®, and highest in controls. Effect sizes were large across all outcomes, indicating clinically meaningful reductions in procedural distress. No adverse events occurred.</p><p><i>Conclusion</i>: Both VR and Buzzy® were associated with reduced procedural distress during SPT, with VR showing greater reductions than Buzzy® in this study. These findings suggest that structured, nurse-led distraction interventions may be beneficial; however, further studies are needed to confirm these results across different clinical settings. The findings suggest that integrating structured, nurse-led distraction strategies, particularly immersive VR, may substantially enhance atraumatic, child-centered care in pediatric allergy settings. The trial was registered at ClinicalTrials.gov in NCT06443060 (12/04/2025).</p><p><Table Float="No" ID="Taba"> <tgroup cols="1"> <colspec align="left" colname="c1" colnum="1" /> <tbody> <row> <entry align="left" colname="c1"> <p><b>What is Known:</b></p> <p>•<i>VR and Buzzy® both reduced pain, fear, and anxiety during SPT.</i></p> <p>•<i>Both interventions were safe and feasible in clinical practice.</i></p> </entry> </row> <row> <entry align="left" colname="c1"> <p><b>What is New:</b></p> <p>•<i>VR was more effective than Buzzy® in reducing these outcomes.</i></p> <p>•<i>Findings support nurse-led, structured distraction strategies in pediatric allergy settings.</i></p> </entry> </row> </tbody> </tgroup> </Table></p>