*4.1. Clinical History*

A convincing clinical history is usually defined as one or more immediate reaction(s) within two hours of peach ingestion, inhalation, or direct contact, presenting as acute urticaria or angioedema, contact urticaria, laryngeal swelling, immediate vomiting, rhinitis, cough, wheezing, bronchospasm, hypotension or loss of consciousness, oral allergy syndrome (i.e., itching and tingling of the lips, oral mucosa and/or tongue), or food-dependent exercise-induced anaphylaxis [40,48,70]. The severity of reactions is useful for suspecting specific patterns of sensitization and proper management. Peamaclein (Pru p 7) frequently elicits anaphylaxis [71] and, similarly to allergy to other gibberellins, often includes peculiar clinical symptoms, such as facial swelling and laryngeal tightness, which can be predictive factors for gibberellin allergies [29]. Because of their labile chemical structure, profilins (Pru p 4 in peach) and PR-10 (Pru p 1 in peach) are usually responsible for mild symptoms [72]. Cofactors should be always investigated (e.g., asthma exacerbations, infections, exercise, alcohol, tiredness, use of NSAIDs, and menstruation), since they usually play a crucial role in eliciting reactions in patients allergic to nsLTP (Pru p 3 in peach) and, less frequently, in

patients allergic to gibberellins (more evident for Pru m 7 (apricot) and Cit s 7 (orange) less for Pru p 7 (peach)). In t patients who have peach-FDEIA, nsLTPs are the most frequent sensitizers, followed by peamaclein [56].

Therefore, the clinical history should include the following: possible causative food(s) (peach and other fruits/vegetables), the time of onset, the extent and reproducibility of symptoms, the identification of allergic symptoms with plants and plants food(s), the quantity of ingested food, details of the food preparation (e.g., raw vs. cooked, peeled vs. unpeeled), and the relevance of cofactors.
