**6. Conclusions**

Peach allergy may manifest with different clinical symptoms of ranging severity. Based on patients' sensitization profiles, clinicians may be able to highlight which patients are more at risk of developing a severe allergic reaction. Unfortunately, in clinical practice, clinicians are only able to dose specific serum IgE for the whole peach source, and for Pru p 1 (PR-10), Pru p 3 (LTP), Pru p 4 (profiline), and Pru p 7 (peamaclein). Patients monosensitized to Pru p 9 are known to be at risk of respiratory symptoms, while patients allergic to Pru p 3 and/or Pru p 7 are at risk of experiencing severe allergic reactions. To properly diagnose a peach allergy, therefore, besides presenting a compatible clinical history related to the fruit, patients need to have positive SPT and/or sIgE to available allergens. In cases in which diagnosis cannot be reached by combining these tests, an OFC may be performed, as this procedure is still considered the gold diagnostic standard. Once the diagnosis is made, patients and caregivers should receive proper education on peach avoidance strategies, an emergency action plan for accidental acute reactions and AAIs in case of history of anaphylaxis to peach. OIT is a promising treatment for patients with food allergies who are at high risk of a life-threatening reaction or severe impairment of quality of life. However, currently, peach immunotherapy is not advised in clinical practice.

**Author Contributions:** Conceptualization, S.B., D.C., F.C., P.C., C.M., U.P., F.P., G.L.M. and S.A.; data curation, S.B., D.C., F.C., P.C., C.M. and S.A.; writing—original draft preparation, S.B., D.C., F.C., P.C., C.M. and S.A.; writing—review and editing, S.B., D.C., F.C., P.C., C.M., U.P., F.P., G.L.M. and S.A.; supervision, S.B., D.C., F.C., P.C., C.M., U.P., F.P., G.L.M. and S.A. All authors have read and agreed to the published version of the manuscript.

**Funding:** The publication fee was financed by the Italian Society of Pediatric Allergy and Immunology (Societa' italiana di allergologia e Immunologia pediatrica, SIAIP, Via Libero Temolo 4, 20126 Milano). However, no significant funding source could have influenced the outcomes of this work.

**Institutional Review Board Statement:** Not applicable.

**Informed Consent Statement:** Not applicable.

**Data Availability Statement:** Not applicable.

**Acknowledgments:** The authors want to thank the Italian Society of Pediatric Allergy and Immunology (Societa' italiana di allergologia e Immunologia pediatrica, SIAIP, Via Libero Temolo 4, 20126 Milano) for its support in relation to this work.

**Conflicts of Interest:** The authors declare no conflict of interest.
