**3. Clinical Manifestations**

Similar to other IgE-mediated food allergic reactions, symptoms appear within minutes to two hours from peach ingestion, except for food-dependent exercise-induced anaphylaxis, which can occur up to 4 h later. Reactions can be triggered by the allergen through the oral route, rarely by inhalation or skin contact, and may affect one or more target organs, including the oral mucosa, the skin, the gastrointestinal tract, the respiratory tract, and the cardiovascular system [40–42].

Immediate peach-induced reactions could be associated with two clinical patterns: the pollen-food allergy syndrome (PFAS) and a primary food allergy [33].

The clinical manifestations of peach allergy depend on the sensitization profile and, consequently, have a peculiar geographical distribution.

In Northern and Central Europe, peach allergy is mainly secondary to pollen allergy. In this condition, also known as PFAS, pollen allergens are the causative agents of the primary sensitization and food allergy to fruits and vegetables results from cross-reactivity between pollen and food allergens. Conversely, in Mediterranean countries, fruit allergy without related pollinosis is often observed and systemic reactions are frequently reported [43,44].

While, on one hand, it is true that allergy to Pru p 1 is mainly associated with pollenfruit allergy syndrome, and that Pru p 9 allergy is associated with respiratory symptoms, on the other hand, patients allergic to either Pru p 3 and/or Pru p 7 are at risk of developing severe symptoms, including anaphylaxis and fatal anaphylaxis [33,45,46].
