Situation: A 41-year-old woman is scheduled for elective open abdominal surgery under general anesthesia, with the skin incision planned for 09:30 tomorrow. Cefazolin 2 g intravenous (IV) is ordered as surgical antibiotic prophylaxis. She has no known drug allergies. During the preoperative assessment she mentions that her lips itch and swell when she eats bananas or kiwi fruit. The nurse then asks whether she has ever reacted to examination gloves, balloons, or urinary catheters. What is the reason for this follow-up question?

Clients allergic to banana, avocado, kiwi, or chestnut often have latex allergy because the proteins cross-react. A positive answer means the operating room must be prepared with latex-free supplies and the team informed before surgery.

Core concept: latex-fruit syndrome

The follow-up question targets a well-documented clinical association called latex-fruit syndrome. In this syndrome, individuals who are sensitized to natural rubber latex proteins also develop IgE-mediated reactions to certain plant foods because the allergenic proteins share structurally similar epitopes ^[1][3]. The fruits most frequently implicated are banana, avocado, kiwi, and chestnut, although other foods such as peach, tomato, potato, and bell pepper have also been reported ^[1][3][4].

When a patient reports itching and swelling of the lips after eating banana or kiwi, the nurse should suspect an underlying latex allergy because the fruit proteins cross-react with latex allergens. The reported symptoms—lip itching and swelling—are consistent with an oral allergy presentation of an IgE-mediated reaction, which is the same immunologic mechanism involved in latex hypersensitivity ^[2][3].

The reason for asking specifically about examination gloves, balloons, and urinary catheters is that these are common medical and household items made of natural rubber latex. A positive history of reactions to any of these items would confirm a clinically significant latex allergy. Identifying latex allergy before surgery is critical because the operating room environment contains numerous latex-containing products, and intraoperative exposure can trigger reactions ranging from contact urticaria to anaphylaxis.

The prevalence data reinforce why this screening matters. Studies indicate that approximately 30–50% of latex-allergic individuals also have associated food allergies, and conversely, 20–60% of latex-allergic patients demonstrate IgE-mediated reactions to fruits ^[1][4]. This bidirectional relationship means that a fruit allergy can serve as an early clinical clue to unrecognized latex sensitization.

Comparison point	Latex-fruit syndrome	Direct latex allergy
Trigger exposure	Ingestion of cross-reactive fruits (banana, kiwi, avocado, chestnut)	Contact with latex products (gloves, catheters, balloons)
Typical symptoms	Oral itching, lip swelling, oropharyngeal discomfort	Contact urticaria, rhinitis, asthma, anaphylaxis
Clinical significance preoperatively	Alerts the nurse to screen for latex allergy	Requires latex-free environment and supplies
Shared mechanism	IgE antibodies recognizing structurally similar epitopes on different proteins [1][3]

The other options are not supported by the evidence. Watch out! Banana or kiwi allergy does not predict cefazolin anaphylaxis. Cefazolin is a beta-lactam antibiotic, and cross-reactivity is a concern primarily with penicillin allergy, not with fruit or latex proteins. Watch out! Propofol contains soybean oil and egg lecithin, but banana and kiwi proteins are not related to egg allergens. Watch out! Iodine skin antiseptics are associated with shellfish allergy or iodine sensitivity, not with fruit or latex cross-reactivity.

The nurse’s follow-up question is therefore a targeted screening for latex allergy, because banana and kiwi share cross-reacting proteins with natural rubber latex. If the patient answers positively regarding gloves, balloons, or catheters, the perioperative team must be notified and the operating room prepared with latex-free supplies before the scheduled open abdominal surgery ^[1][3][4].