Fragrance contact dermatitis: A worldwide multicenter investigation (Part I)

doi:10.1016/S1046-199X(96)90078-0

American Journal of Contact Dermatitis

Volume 7, Issue 2, June 1996, Pages 77-83

https://doi.org/10.1016/S1046-199X(96)90078-0 Get rights and content

Abstract

$Objective:$ The aim of this study was to determine the prevalence of responses to selected fragrance materials in patients with suspect fragrance allergy and to evaluate risk factors and associations with such responses. The validity of using specific fragrance ingredients versus a mixture of fragrances was evaluated in terms of predicting allergy to different fragrance ingredients.

$Methods:$ One hundred sixty-seven subjects were evaluated in seven centers worldwide with a fragrance mix, the eight ingredients in the fragrance mixture, six other well-known fragrance allergens, balsam of Peru, and 15 lesser studied fragrance materials.

$Results:$ The age of the patients was 44.9 ± 17.5 years (mean ± SD). More than 85% were women. A relatively high proportion gave a past history of atopic disease. Facial eruptions (40%) and hand involvement (26.7%) were the most common topographic sites. All but 4 of the 35 fragrance materials produced a positive response in > 1%. A reaction to fragrance mix occurred in 47.3%. Seven of the 34 ingredients tested produced an allergic response in more than 10% of those tested. Men were more likely than women to exhibit a positive response to five fragrance ingredients. White persons were more likely to react to perfume mix (52.8% versus 25.3%) and certain ingredients in the mix than Asian persons. Allergy to benzyl salicylate was more common in Japan than in Europe or the United States.

$Conclusion:$ The age at which patients with perfume allergy present for evaluation is similar to that of other contactants. Atopic individuals may be overrepresented in this group of patients. Face involvement is likely. White persons are more likely to react to fragrance mix, whereas in Asian patients benzyl salicylate was a more frequent allergen. Fragrance mix coreacted with 85.6% of positive responses to fragrance ingredients. The addition of ylang ylang oil, narcissus oil, and sandalwood oil to fragrance mix would be expected to pick up 94.2% with positive responses to fragrance materials; adding balsam of Peru increases this to 96%.

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Chemicals that can be used to help detect fragrance allergy include cinnamic aldehyde (on the North American Contact Dermatitis Group [NACDG] standard but not on the Thin-layer Rapid Use Epicutaneous [T.R.U.E.] Test [SmartPractice, Phoenix, AZ]), fragrance mix I (a NACDG standard and T.R.U.E. Test allergen), fragrance mix II (on the NACDG standard but not on the T.R.U.E. Test), and Myroxylon pereirae (a NACDG standard and T.R.U.E. Test allergen). One study found that patients who were allergic to fragrance mix I had coreactions to various other fragrance chemicals not present in the mix.8 Allergy to fragrance mix I was detected in 8.5% of the approximately 4300 patients with dermatitis who were tested by the NACDG.9
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La dermatitis de contacto alérgica por fragancias suele presentarse clínicamente como un eczema subagudo o crónico debido a la ubicuidad de este alérgeno en los productos de uso cotidiano y el contacto repetido. El paciente típico es una mujer de edad media con afectación de las manos y la cara, aunque la localización de las lesiones variará dependiendo del alérgeno y del producto causante. Dentro de la batería estándar del Grupo Español en Investigación de Dermatitis de Contacto y Alergia Cutánea (GEIDAC) están incluidos 4 marcadores de fragancias: el bálsamo del Perú, la mezcla de fragancias i, la mezcla de fragancias ii y el lyral. En caso de que alguno de estos marcadores sea positivo está indicada la utilización de una serie de fragancias específicas para el diagnóstico. Esto, unido a la nueva legislación que obliga a la industria a notificar qué ingredientes y fragancias utiliza en sus productos, nos ayudará a la resolución de la dermatitis de pacientes alérgicos.
Allergic contact dermatitis due to fragrances usually manifests as subacute or chronic dermatitis because fragrances are found in a wide range of products to which patients are repeatedly exposed. The typical patient is a middle-aged woman with dermatitis on her hands and face, although other sites may be affected depending on the allergen and the product in which it is found. The standard patch test series of the Spanish Contact Dermatitis and Skin Allergy Research Group (GEIDAC) contains 4 fragrance markers: balsam of Peru, fragrance mix i, fragrance mix ii, and lyral. Testing with a specific fragrance series is recommended in patients with a positive result to any of these 4 markers. The use of a specific fragrance series and new legislation obliging manufacturers to specify the fragrances used in their products, will help to improve the management of allergic contact dermatitis due to fragrances.

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Original articleFragrance contact dermatitis: A worldwide multicenter investigation (Part I)☆

Abstract

J Am Acad Dermatol

Food Chem Toxicol

Epidemiology of hand eczema in an industrial city

Acta Derm Venereol Suppl (Stockh)

An epidemiological comparison between hand eczema and non-hand eczema

Br J Dermatol

Study on Chinese common allergens of contact dermatitis

Derm Beruf Umwelt

Patch testing in Hong Kong

Contact Dermatitis

Patch testing with perfume mixture

Acta Derm Venereol (Stockh)

Finn chamber patch test technique

Contact Dermatitis

Epicutaneous testing with a standard series

Dermatitis from contact with perfume

Allerg Immunol (Paris)

Patch testing with a routine screening tray in North America, 1985 through 1989. I: Frequency of response

Am J Contact Dermatitis

Epicutaneous testing

Ann Allergy

Sensitivity and specificity of patch tests

Am J Contact Dermatitis

Recent experiences with routine patch test screening

Arch Dermatol

The American Academy of Dermatology patch test series for contact dermatitis

Int J Dermatol

Computer data on patch tests of 688 eczema patients

Contact Dermatitis

Original article
Fragrance contact dermatitis: A worldwide multicenter investigation (Part I)☆