The molecular landscape of peach allergy in Tunisia: New Insights

Nader Ben Nejma^1,2Dhouha Krir^1,2Yousr Galai^1,3Ahlem Ben Hmid^1,2,4Ines Ben Sghaier¹Yosra Nasri¹Hayet Kbaier¹Louzir Hechmi^2,4Nissaf Bouaffif Alya^2,5Mélika Ben Ahmed^1,2,4Imen Zamali^1,2,4*Samar Samoud^1,4,6*

• ¹Laboratory of Clinical Immunology, Institut Pasteur de Tunis, 1002, Tunis, Tunisia
• ²Faculty of Medicine de Tunis, University of Tunis El Manar, 1068, Tunis, Tunisia
• ³Faculty of pharmacy of Monastir, University of Monastir, 5000, Monastir, Tunisia
• ⁴Laboratory of Transmission, Control and Immunobiology of Infection, Institut Pasteur de Tunis, 1002, Tunis, Tunisia
• ⁵National Observatory of New and Emerging Diseases, Ministry of Health, 1002, Tunis, Tunisia
• ⁶Faculty of Medicine of Sousse, University of Sousse, 4000, Sousse, Tunisia

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: A retrospective study was conducted including 63 patients referred for suspected peach allergy to the Pasteur Institute of Tunisia between March 2022 and March 2025. After application of exclusion criteria, 49 patients were included in the final analysis. Total and specific IgE levels were measured using ImmunoCAP® 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 This is a provisional file, not the final typeset article 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.