Peach Allergies: Symptoms And Management

  • Mai Nguyen Pharmacology BSc, University College London
  • Maria Weissenbruch Doctor (Ph.D.), Cell and Developmental Biology, Karlsruhe Institute of Technology (KIT), Germany

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative

Introduction

Peaches, a part of the stone fruit family belonging to the Rosaceae family of fruits, are filled with vitamins, minerals and antioxidants. However, some are not able to enjoy the taste and nutrients of peaches due to peach allergies. Peach allergies are becoming a more common form of fruit allergy in Europe, with overall European prevalence increasing from 5.4% in 2010, to 7.9% in 2014. It is most prevalent in the Mediterranean  area, the reasoning behind this is still currently unknown.1 It is important to understand the symptoms of peach allergies, or other cross-reactive foods, and how to manage this condition. 

Peach allergy symptoms 

Like many other food allergic reactions, symptoms may appear from 2 minutes to 2 hours after sensitisation. Symptoms may be triggered via oral consumption, inhalation, or skin contact, affecting the skin, respiratory system and gastrointestinal tract. Skin reactions like itchiness, redness and hives are common under an allergic reaction. Swelling can also occur in the lips, tongue, face and throat, which can lead to respiratory symptoms such as shortness of breath and wheezing. Other respiratory symptoms include sneezing and a runny or stuffy nose. While less common, patients may experience gastrointestinal symptoms such as nausea, vomiting, abdominal pain, or diarrhoea a.2 Severe allergic reactions may lead to anaphylactic shock or severe asthma attacks.6

The causes of peach allergies 

  1. Proteins responsible

There are six peach allergen proteins currently known to cause peach allergy. Sensitisation to the Pru p 1, 3, 4, 7, 9 proteins manifests the symptoms of the peach allergy. Pru p 1 is a member of the PR-10 protein family and is found in commonly found in areas with high birch pollen count, it cross-reacts with other Rosaceae fruits, nuts, carrots and celery. “True” peach allergies arise from an IgE reaction to the Pru p 3 protein, it is not associated with other pollen allergies. Sensitisation of the Pru p 3 allergen is seen in over 90 % of peach allergies in the Mediterranean.3 Pru p 4 is found in the pulp and peel of the peach, it cross-reacts with profilins in pollen. Pru p 7 is a major allergen-causing sensitisation in 54% of suspected peach allergy patients conducted in 2019.4 Pru p 9 is a new occupational allergen found in peach tree pollen.5

  1. Cross-Reactivity

The cause of peach allergy varies in different geographical locations. North and Central Europe peach allergies are significantly related to pollen allergies, specifically birch pollen allergies, resulting from cross-reactivity. Cross-reactivity is when an allergy to two or more unrelated foods occurs due to the immune system recognising them as similar substances. These patients would generally have allergies to other foods like Rosaceae fruits, nuts, and vegetables.6 On the other hand, peach allergies in the Mediterranean are completely unrelated to pollinosis and cross-reactivity. However, symptoms of peach allergy present more severe.7 Oral allergy syndrome after the consumption of peaches can be linked to cross-reactive IgE to birch pollen and fruits.8 Peach allergy and peach sensitivity are sometimes used interchangeably, but it should be noted that they are two very different reactions. Peach allergies cause the production of IgE antibodies as part of an immune response, whereas peach sensitivity is where an IgE antibody response is triggered. The symptoms of peach allergies appear shortly after contact with peaches, whereas peach sensitivity can take several hours, or even days, to elicit symptoms. Symptoms profile may also differ with diarrhoea, bloating, skin conditions, and headaches more common with peach sensitivity.3

  1. Genetic predispositions 

Genetics may play a factor in the development of peach allergies. The immune system is regulated by HLA (human leucocyte antigens), and there are 3 classes of HLA: HLA-DR, HLA-DQ and HLA-DP. GWAS studies reveal that having the A or T allele SNP (single nucleotide polymorphism) in the HLA-DR/DQ gene region increases the risk of developing peach allergies.13

Diagnosis of peach allergies

Seeking medical attention is extremely important when there is a suspected allergy. The first step to peach allergy diagnosis is an evaluation of clinical history, with an indication for positive peach allergy and a symptomatic reaction within 2 hours of contact. A skin prick test can also be conducted. Here the duration and severity of the reaction are noted, as this is a good indication of  patterns of sensitivity and appropriate management. Another useful tool for diagnosis is IgE sensitisation screening, however, its use without previous review of clinical history is strongly discouraged.9 Blood is taken from the patient to analyse the level of IgE in the bloodstream, increased levels of IgE indicate positive results for a confirmed allergy. If a definitive diagnosis cannot be provided from the patient’s clinical history and IgE screening, then an oral food challenge (OFC) may be conducted under strict medical supervision. The patient is exposed to increasing concentrations of the allergen, some OFC protocols may test the peach peel and pulp separately.10

Management and treatment

Currently, there is no effective “cure” for peach allergies, however, management of peach allergies can be divided into exposure reduction, symptom relief, emergency plans and immunotherapy. The main preventative strategy following diagnosis is avoidance: the patient should eliminate peaches from their diet and actively avoid peaches and peach-contaminated products. This can be achieved by reading labels on food and making sure restaurants are aware of their allergy. For severe peach allergies, be wary of cross-contaminated products, for example, tongs at a salad bar. Primary management of peach allergies includes long-term avoidance, temporary symptom relief, emergency reactions, and immunotherapy. If mild symptoms appear after coming into contact with peaches, measures can be taken to provide relief. Rinsing the skin under water following contact can provide some relief from itching. Minor allergic reactions can be treated by taking antihistamines to relieve the symptoms of itching, hives, nasal congestion, and sneezing. Allergy shots for peach allergies caused by cross-sensitization with pollen may be used to help with an allergic reaction. Bronchodilators can be used as supplementary therapy for the respiratory symptoms of peach allergies. Emergency treatment plans include always carrying at least two adrenaline auto-injectors. In cases where you may not be able to administer the adrenaline yourself, ensure that the auto-injectors have clear instructions on them. It may be useful to educate and inform family and close friends on the methods of proper auto-injector usage.11 Allergen immunotherapy may be a preferred long-term treatment option for those looking to induce immunological tolerance. Oral immunotherapy involves consuming increasing amounts of peach to induce desensitisation and, possibly, tolerance. Sublingual immunotherapy strategies have proven effective in 70.8% of patients in a study, without the occurrence of side effects.12

Living with a peach allergy

Living with peach allergies can be challenging, but there are steps you can take to cope. It is important to create an environment that is safe and prevents the onset of an allergic reaction. This can be achieved by informing and educating friends, family, school, and work environments on allergies and the necessary steps to take if a reaction arises. Always inform restaurants about your allergies and ensure that you check labels to see if they contain peaches or any related foods. It is often the case that other stone fruit and other members of the Rosaceae family may cause an allergic reaction. Seek alternative non-cross reactive fruit options, like bananas. For some patients, an allergic reaction is only triggered by coming into contact with raw peaches or swapping out raw peaches for cooked or processed peaches. Peaches under high temperatures and processing procedures can break down the protein responsible for the allergy. On top of the physical impact of peach allergies, the psychological impact may be even more challenging. Hypervillegence surrounding eating and mealtime can cause mental strain, restricted social interactions and overall major anxiety. Consulting with allergists and therapists with experience with food-related disorders and help ease the mental pressures of peach allergies. 

Summary

To conclude, peach allergies are common among food allergies, especially in certain parts of the world like the Meditterean area. The severity of symptoms may vary, with common symptoms being itchiness, swelling, and congestion. The cause of peach allergies lies in the Pru p- proteins and cross-reactivity with birch pollen. Preventative measures and coping strategies centre around avoidance and education surrounding the symptoms and management of peach allergies. Emergency treatment primarily involves adrenaline auto-injectors. Long-term management includes immunotherapy and allergen desensitisation. Seeking a diagnosis from a professional is incredibly important, as pinpointing the severity of the allergy and its cause can help with its management. The future for peach allergies involves further research into alternative management and encouraging the spread of awareness and education on allergies. 

References

  1. Burney PGJ, Potts J, Kummeling I, Mills ENC, Clausen M, Dubakiene R, et al. The prevalence and distribution of food sensitization in European adults. Allergy. 2014 Mar;69(3):365–71.
  2. Barni S, Caimmi D, Chiera F, Comberiati P, Mastrorilli C, Pelosi U, et al. Phenotypes and Endotypes of Peach Allergy: What Is New? Nutrients. 2022 Feb 26;14(5):998.
  3. Peach Allergy: Pinpointing The Symptoms, Cross-Reactive Foods, Tests and Treatment [Internet]. Available from: https://www.yorktest.com/us/blog/peach-allergy/#:~:text=An%20allergy%20to%20peaches%20may,protein%20found%20in%20the%20fruit
  4. Klingebiel C, Chantran Y, Arif-Lusson R, Ehrenberg AE, Östling J, Poisson A, et al. Pru p 7 sensitization is a predominant cause of severe, cypress pollen-associated peach allergy. Clin Exp Allergy. 2019 Apr;49(4):526–36.
  5. Victorio Puche L, Somoza ML, López-Sánchez JD, Garrido-Arandia M, Díaz-Perales A, Blanca M. Peach Tree Pollen and Prunus persica 9 Sensitisation and Allergy in Children and Adolescents. Int Arch Allergy Immunol. 2019;180(3):212–20..
  6. Allergy information for: Peach (Prunus persica) [Internet]. The University of Manchester; Available from: http://research.bmh.manchester.ac.uk/informall/allergenic-food/index.aspx?FoodId=37.
  7. Fernández-Rivas M, Bolhaar S, González-Mancebo E, Asero R, van Leeuwen A, Bohle B, et al. Apple allergy across Europe: how allergen sensitization profiles determine the clinical expression of allergies to plant foods. J Allergy Clin Immunol. 2006 Aug;118(2):481–8.
  8. Björkstén F, Halmepuro L, Hannuksela M, Lahti A. Extraction and properties of apple allergens. Allergy. 1980 Dec;35(8):671–7.
  9. Poncet P, Sénéchal H, Charpin D. Update on pollen-food allergy syndrome. Expert Rev Clin Immunol. 2020 Jun;16(6):561–78.
  10. Kennard L, Thomas I, Rutkowski K, Azzu V, Yong PFK, Kasternow B, et al. A Multicenter Evaluation of Diagnosis and Management of Omega-5 Gliadin Allergy (Also Known as Wheat-Dependent Exercise-Induced Anaphylaxis) in 132 Adults. J Allergy Clin Immunol Pract. 2018;6(6):1892–7.
  11. Muraro A, Werfel T, Hoffmann-Sommergruber K, Roberts G, Beyer K, Bindslev-Jensen C, et al. EAACI food allergy and anaphylaxis guidelines: diagnosis and management of food allergy. Allergy. 2014 Aug;69(8):1008–25.
  12. Navarro B, Alarcón E, Claver Á, Pascal M, Díaz-Perales A, Cisteró-Bahima A. Oral immunotherapy with peach juice in patients allergic to LTPs. Allergy Asthma Clin Immunol. 2019;15:60.
  13. Khor SS, Morino R, Nakazono K, Kamitsuji S, Akita M, Kawajiri M, et al. Genome-wide association study of self-reported food reactions in Japanese identifies shrimp and peach specific loci in the HLA-DR/DQ gene region. Sci Rep. 2018 Jan 18;8(1):1069.

Get health & wellness advice into your inbox

Your privacy is important to us. Any information you provide to us via this website may be placed by us on servers. If you do not agree to these placements, please do not provide the information.

Best Milk Alternative
[optin-monster-inline slug="yw0fgpzdy6fjeb0bbekx"]
This content is purely informational and isn’t medical guidance. It shouldn’t replace professional medical counsel. Always consult your physician regarding treatment risks and benefits. See our editorial standards for more details.

Get our health newsletter

Get daily health and wellness advice from our medical team.
Your privacy is important to us. Any information you provide to this website may be placed by us on our servers. If you do not agree do not provide the information.

Ngoc Mai Nguyen

Pharmacology BSc, University College London

Mai is a recent graduate with years of experience with academic writing. With a special interest in human disorders, she has experience assisting the publication of scientific journals on autism and Fragile X Syndrome.

my.klarity.health presents all health information in line with our terms and conditions. It is essential to understand that the medical information available on our platform is not intended to substitute the relationship between a patient and their physician or doctor, as well as any medical guidance they offer. Always consult with a healthcare professional before making any decisions based on the information found on our website.
Klarity is a citizen-centric health data management platform that enables citizens to securely access, control and share their own health data. Klarity Health Library aims to provide clear and evidence-based health and wellness related informative articles. 
Email:
Klarity / Managed Self Ltd
Alum House
5 Alum Chine Road
Westbourne Bournemouth BH4 8DT
VAT Number: 362 5758 74
Company Number: 10696687

Phone Number:

 +44 20 3239 9818