From Gloves to Fruits: COVID-19–Era Changes in Latex-Fruit Allergy Risk

Emergency departments have historically been early witnesses to unintended consequences of public health interventions. During the late 1980s and early 1990s, the HIV/AIDS epidemic prompted the adoption of universal precautions, dramatically increasing the use of natural rubber latex gloves across healthcare settings. In the years that followed, a marked rise in IgE-mediated latex allergy was documented among healthcare workers and patients, establishing a clear link between intensified latex exposure and allergic sensitization. The COVID-19 pandemic recreated a strikingly similar exposure environment. Once again, glove use surged, this time not only in hospitals, but also in community, retail, and home settings, which raises the question of whether this renewed exposure altered patterns of latex-associated allergic disease. Latex–fruit syndrome is a well-described immunologic phenomenon in which IgE antibodies directed against latex proteins cross-react with structurally homologous plant proteins found in certain fruits and vegetables. Banana, avocado, chestnut, and kiwi are most commonly implicated, though reactions have been reported with several other foods. Clinically, these reactions range from mild oral allergy symptoms to systemic urticaria, bronchospasm, and anaphylaxis, which are frequently evaluated in the emergency department. Despite this relevance, population-level shifts in individual latex-associated food allergies during the COVID-19 era have not been systematically examined. Using a large real-world database, we analyzed incidence proportion, prevalence, and incidence rates of latex-associated food allergies across three distinct periods: pre-COVID, COVID-19, and post-COVID. Rather than aggregating all foods under a single latex–fruit syndrome category, we examined individual fruits to determine whether sensitization patterns changed uniformly or differed by food type during periods of heightened latex exposure. Across nearly all evaluated foods, allergy prevalence increased during the COVID-19 and post-COVID periods compared with baseline. However, the magnitude of change varied substantially by fruit. Banana allergy demonstrated the highest absolute prevalence across all three periods and showed a pronounced increase during and after the pandemic. Avocado, chestnut, kiwi, peach, and tomato also exhibited rising prevalence, though to varying degrees. In contrast, potato showed relatively modest changes, and bell pepper remained rare throughout all periods. When changes were expressed as fold-change relative to the pre-COVID baseline, this heterogeneity became more apparent. Several fruits showed disproportionate increases during the pandemic period, suggesting that intensified latex exposure may preferentially amplify sensitization to certain cross-reactive foods rather than producing a uniform rise across all latex-associated foods. Banana, in particular, emerged as a key allergen, both highly prevalent and highly responsive to shifts in exposure. For emergency clinicians, these findings have practical implications. Patients presenting with unexplained allergic reactions during periods of widespread glove use may have newly developed sensitivities to common foods rather than obvious latex exposures alone. Recognizing fruit-specific patterns of latex-associated allergy may improve diagnostic suspicion, guide patient counseling, and inform anticipatory guidance during future public health emergencies. By revisiting lessons from the HIV/AIDS era through the lens of COVID-19, this analysis highlights how infection-control practices can reshape allergic risk landscapes and how those changes often surface first in the emergency department.