The molecular landscape of peach allergy in Tunisia: new insights

Background: Peach allergy represents a significant clinical problem in Mediterranean populations, yet molecular characterization remains limited in North African countries. This study provides the first comprehensive analysis of peach sensitization patterns in Tunisia using component-resolved diagnostics. Objective: To characterize molecular sensitization profiles to peach allergen components, correlate these with clinical manifestations, and evaluate predictive biomarkers in a Tunisian cohort. Methods: technology. Component-resolved diagnostics targeted rPru p 1, rPru p 3, rPru p 4, and rPru p 7. Reaction severity was assessed using oFASS-3. Statistical analyses included correlation studies and ROC curve analysis. Results: Thirty-eight patients (77.5%) demonstrated peach allergy with median age 10 years [7-14]. Clinical manifestations included urticaria (86.6%), angioedema (39.4%), respiratory symptoms (rhinitis 42.1%, bronchospasm 23.6%), oral allergy syndrome (32.4%), and anaphylaxis (10.5%). Pru p 3 was predominant (84.2% of patients, median 1.215 kUA/L). Pru p 7, Pru p 1, and Pru p 4 sensitization occurred in 10.5%, 7.8%, and 2% respectively. Peach-specific IgE predicted Pru p 3 sensitization with 100% sensitivity and 66.7% specificity (cut-off 0.23 kUA/L). Strong correlation existed between peach-specific IgE and Pru p 3 levels (ρ = 0.942). No associations were identified between biomarkers and clinical severity. Conclusions: Peach allergy in Tunisia follows the Mediterranean phenotype with predominant Pru p 3 sensitization and significant clinical severity. These findings establish the molecular foundation for evidence-based diagnosis while highlighting the need for region-specific therapeutic approaches.