**4. Diagnosis**

As with any diagnostic workup for food allergy, screening allergen-sIgE testing without clinical necessity is discouraged [40,47,70]. A detailed clinical history is therefore crucial for selecting the appropriate confirmatory tests. According to the ICON and EAACI guidelines for food allergies [40], the diagnosis of peach allergy lies on the combination of a convincing clinical history of immediate reaction to peach and positive IgE sensitization testing assessed through SPT to peach (in the form of either extract, molecular components, or fresh peach), and/or IgE sensitization to peach (either extracts or molecular components). Where the diagnosis is unclear, an oral food challenge (OFC) is required as the gold standard test to provide a definitive diagnosis and to prevent patients from unneeded and potentially harmful elimination diets. However, OFC is logistically demanding, and anaphylactic reactions may occur. Reliable prognostic markers or algorithms integrating different clinical and biological parameters for predicting the severity of allergic reactions during OFC are under investigation.
