*3.1. Peach Allergy Secondary to Pollen Allergy*

The allergen families involved in peach-induced PFAS include PR10 proteins, profilins, nsLTPs, thaumatin-like proteins, and gibberellin-regulated proteins [47].

PFAS account for up to 60% of food allergies in adult patients and adolescents. It may affect one or more target organs: the skin, the oral mucosa, the gastrointestinal tract, the respiratory tract, and the cardiovascular system [47,48].

The most frequent clinical pattern observed in adult patients and adolescents with PFAS is OAS. Symptoms emerge within 5–15 min of food ingestion and consist of tingling/itching of the lips, tongue, oral mucosa, palate, and throat, with possible mild angioedema associated at the same sites [48].

Most cases resolve spontaneously within 30 min, but 3% of patients present systemic reactions without oropharyngeal symptoms, and 1–8% develop systemic reactions, such as urticaria, dyspnea, wheezing, and anaphylaxis [49–51].

Acute generalized urticaria, with or without angioedema, and contact urticaria are the second most frequently observed symptoms of PFAS. Gastrointestinal symptoms, such as nausea, vomiting, abdominal pain, and diarrhea are rarely seen as exclusive manifestations of PFAS. Respiratory symptoms, such as rhinoconjunctivitis, bronchospasm, and laryngeal edema occur more frequently in association with other target organs symptoms rather than in isolation [48].

The presence of comorbidities (atopic dermatitis) and cofactors (exercise, alcohol consumption, use of non-steroidal anti-inflammatory drugs (NSAIDs)) increases the severity of symptoms and the risk of anaphylaxis [50].
