# 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?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629867  
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> subject: Nursing Practice III — Care of Clients with Problems in Surgery, Oxygenation, Fluid and Electrolytes, Infectious, Inflammatory and Immunologic Response, Cellular Aberrations

## 문제

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?

## 보기

1. Food allergy raises the chance of anaphylaxis to cefazolin
2. This fruit allergy suggests a reaction to the egg in propofol
3. Any food allergy predicts a reaction to iodine skin antiseptics
4. These fruits share cross-reacting proteins with latex **✔ 정답**

**정답: 4**

## 해설

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.

## 심화 해설

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].References (research sources)

- [1]The latex-fruit syndrome.Research articleWagner S, Breiteneder H (2002) · DOI: 10.1042/bst0300935

- [2]Revisiting Latex-Fruit Syndrome after 30 Years of Research: A Comprehensive Literature Review and Description of Two Cases.Research articleGromek W, Kołdej N, Świtała S, Majsiak E, Kurowski M (2024) · DOI: 10.3390/jcm13144222

- [3]Latex-fruit syndrome.Research articleBlanco C (2003) · DOI: 10.1007/s11882-003-0012-y

- [4][Latex-fruit syndrome].Research articleBlanco Guerra C (2002) · DOI: 10.1016/s0301-0546(02)79109-x

## 임상 시나리오

Latex-Fruit Syndrome Screening Before SurgeryBanana or kiwi allergy is a red flag for latex allergy
Patients reporting lip itching or swelling after eating banana, avocado, kiwi, or chestnut may have latex-fruit syndrome due to cross-reacting proteins.

Ask specifically about reactions to examination gloves, balloons, or urinary catheters—common natural rubber latex items. A positive history confirms clinically significant latex allergy.

If latex allergy is suspected, notify the operating room team and prepare latex-free supplies before the scheduled 09:30 incision.

CautionIntraoperative latex exposure can trigger reactions from contact urticaria to anaphylaxis. Do not dismiss fruit allergy as irrelevant to surgical planning.

## 핵심 개념

- **latex-fruit syndrome** — Cross-reactivity between natural rubber latex proteins and certain fruit proteins (banana, avocado, kiwi, chestnut) due to shared IgE epitopes.
- **oral allergy syndrome** — IgE-mediated local symptoms such as lip itching and swelling after eating cross-reactive plant foods.
- **natural rubber latex** — Material derived from Hevea brasiliensis used in gloves, balloons, catheters, and many medical products.
- **surgical antibiotic prophylaxis** — Antibiotic given before incision to reduce surgical site infection risk; cefazolin is a common choice.
- **anaphylaxis** — Severe systemic IgE-mediated hypersensitivity reaction that can occur with intraoperative latex exposure.

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