(214) Immunologic Drivers of Fruit-Specific Allergy Patterns in Latex–Fruit Syndrome

Introduction/Rationale: Latex–fruit syndrome is an IgE-mediated hypersensitivity disorder resulting from cross-reactivity between natural rubber latex allergens and structurally homologous plant proteins. Fruits associated with this syndrome display varying molecular similarity to latex allergens through shared IgE-binding epitopes, such as hevein-like domains and class I chitinases. These immunologic differences likely contribute to heterogeneity in the clinical burden of latex-associated food allergy; however, fruit-specific population-level patterns are not well characterized. Enhanced characterization of allergen-specific cross-reactivity could elucidate mechanisms underlying the differential clinical expression of latex–fruit syndrome.

Methods: A retrospective cohort study was conducted using the TriNETx federated electronic health record network. Patients with documented natural rubber latex allergy were identified. Fruit-specific allergy diagnoses were evaluated for foods commonly implicated in latex–fruit syndrome, including avocado, banana, chestnut, kiwi, peach, tomato, potato, and bell pepper. Incidence proportion, prevalence, and incidence rates were assessed across pre-COVID, COVID, and post-COVID periods. Fold-change analyses were performed to compare fruit-specific prevalence between the pre-COVID and post-COVID periods.

Results: The burden of latex-associated food allergy varied substantially by fruit. The largest increases in post-COVID prevalence were observed for avocado (2.06), peach (1.94), kiwi (1.90), banana (1.77), and chestnut (1.66). More modest increases occurred for tomato (1.46) and potato (1.21), whereas bell pepper demonstrated no meaningful increase (4.94 × 10⁻⁵).

Conclusion: Fruit-specific differences in the burden of latex-associated food allergy parallel established immunologic mechanisms of IgE cross-reactivity, supporting a biological basis for the differential clinical expression of latex–fruit syndrome.