Advertisement

American Journal of Clinical Dermatology

, Volume 4, Issue 11, pp 789–798 | Cite as

Fragrance Contact Allergy

A Clinical Review
  • Jeanne D. JohansenEmail author
Review Article

Abstract

Most people in modern society are exposed daily to fragrance ingredients from one or more sources. Fragrance ingredients are also one of the most frequent causes of contact allergic reactions. The diagnosis is made by patch testing with a mixture of fragrance ingredients, the fragrance mix. This gives a positive patch-test reaction in about 10% of tested patients with eczema, and the most recent estimates show that 1.7–4.1% of the general population are sensitized to ingredients of the fragrance mix. Fragrance allergy occurs predominantly in women with facial or hand eczema. These women typically have a history of rash to a fine fragrance or scented deodorants. Chemical analysis has revealed that well known allergens from the fragrance mix are present in 15–100% of cosmetic products, including deodorants and fine fragrances, and most often in combinations of three to four allergens in the same products. This means that it is difficult to avoid exposure, as products labelled as ‘fragrance free’ have also been shown to contain fragrance ingredients, either because of the use of fragrance ingredients as preservatives or masking perfumes, or the use of botanicals.

About 2500 different fragrance ingredients are currently used in the composition of perfumes and at least 100 of these are known contact allergens. Therefore, it is advisable to supplement standard patch testing with the patient’s own stay-on cosmetic products, as well as the fragrance chemical hydroxyisohexyl-3-cyclohexane carboxaldehyde, which on its own gives responses in 1–3% of tested patients. The focus in recent years on the ingredients of the fragrance mix will probably result in the fragrance industry changing the composition of perfumes, and thus make the current diagnostic test less useful. New diagnostic tests are under development to identify contact allergy to new allergens, reflecting the continuous developments and trends in exposure.

Keywords

Cosmetic Product Contact Allergy Natural Extract Isoeugenol Hand Eczema 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Acknowledgments

No sources of funding were used to assist in the preparation of this manuscript. The author has no conflicts of interest that are directly relevant to the content of this manuscript.

References

  1. 1.
    Frosch PJ, Pilz B, Andersen KE, et al. Results from a multicenter study of the European Environmental and Contact Dermatitis Research Group with 48 frequently used constituents of perfumes. Contact Dermatitis 1995; 33: 333–42PubMedCrossRefGoogle Scholar
  2. 2.
    Marks JG, Belsito DV, Deleo VA, et al. North American Contact Dermatitis Group patch test results, 1996–1998. Arch Dermatol 2000; 136: 272–3PubMedCrossRefGoogle Scholar
  3. 3.
    Nielsen NH, Menné T. Allergic contact sensitization in an unselected Danish population: The Glostrup Allergy Study. Acta Derm Venereol (Stockh) 1992; 72: 456–60Google Scholar
  4. 4.
    Rustemeyer T, van Hoogstraten I, von Blomberg BME, et al. Mechanisms in allergic contact dermatitis. In:Rycroft RJG, Menné T, Frosch PJ, Lepoittevin JP, editors. Textbook of contact dermatitis. 3rd ed. Berlin: Springer, 2001: 13–58Google Scholar
  5. 5.
    Buckley DA, Wakelin SH, Holloway D, et al. The frequency of fragrance allergy in a patch test population over a seventeen-year period. Br J Dermatol 2000; 142: 279–83PubMedCrossRefGoogle Scholar
  6. 6.
    Meding B. Epidemiology of hand eczema in an industrial city [thesis]. Acta Derm Venerol Suppl (Stockh) 1990; 153: 1–43Google Scholar
  7. 7.
    Harder U. The art of creating a perfume. In: Frosch PJ, Johansen JD, White IR, editors. Fragrances: beneficial and adverse effects. Berlin: Springer-Verlag, 1998: 3–5Google Scholar
  8. 8.
    The Scientific Committee on Cosmetic Products and Non-Food Products (SCCNFP) intended for consumers. Opinion concerning fragrance inventory. Adopted by the SCCNFP during the plenary session of 23 September 1998Google Scholar
  9. 9.
    Butler H. Historical background. In: Butler H, editor. Poucher’s perfumes, cosmetics and soaps. 9th ed. London: Chapman & Hall, 1993: 639–93CrossRefGoogle Scholar
  10. 10.
    Müller J. The H&R book of perfume: understanding fragrance, origin, history, development: guide to fragrance ingredients. Hamburg, Germany: Glöss Verlag, 1992Google Scholar
  11. 11.
    de Groot AC, Frosch PJ. Adverse reactions to fragrances: a clinical review. Contact Dermatitis 1997; 36: 57–87PubMedCrossRefGoogle Scholar
  12. 12.
    Katz AS, Sheretz F. Facial dermatitis: patch test results and final diagnosis. Am J Contact Dermat 1999; 10: 153–6PubMedCrossRefGoogle Scholar
  13. 13.
    Buckley DA, Rycroft RJG, White IR, et al. Contact allergy to individual fragrance mix constituents in relation to primary site of dermatitis. Contact Dermatitis 2000; 43: 304–5PubMedGoogle Scholar
  14. 14.
    Johansen JD, Andersen TF, Kjøller M, et al. Identification of risk products for fragrance contact allergy: a case-referent study based on patients’ histories. Am J Contact Dermat 1998; 2: 80–7CrossRefGoogle Scholar
  15. 15.
    Larsen WG. Perfume dermatitis: a study of 20 patients. Arch Dermatol 1977; 113: 623–6PubMedCrossRefGoogle Scholar
  16. 16.
    Frosch PJ, Johansen JD, Menné T, et al. Lyral® is an important sensitizer in patients sensitive to fragrances. Br J Dermatol 1999; 141: 1076–83PubMedCrossRefGoogle Scholar
  17. 17.
    Frosch PJ, Pirker C, Johansen JD, et al. New markers for fragrance hypersensitivity. Abstract at the 5th Congress of the European Society of Contact Dermatitis. Contact Dermatitis 2000; 42 Suppl. 2: 51Google Scholar
  18. 18.
    Larsen W, Nakayama H, Lindberg M, et al. Fragrance contact dermatitis: a worldwide multicentre investigation (Pt I). Am J Contact Dermat 1996; 7: 77–83PubMedCrossRefGoogle Scholar
  19. 19.
    Larsen W, Nakayama H, Fischer T, et al. A study of new fragrance mixtures. Am J Contact Dermat 1998; 9: 202–6PubMedCrossRefGoogle Scholar
  20. 20.
    Larsen WG. How to test for fragrance allergy. Cutis 2000; 65: 39–41PubMedGoogle Scholar
  21. 21.
    Geier J, Brasch J, Schnuch A, et al. Lyral® has been included in the patch test standard series in Germany. Contact Dermatitis 2002; 46: 295–7PubMedCrossRefGoogle Scholar
  22. 22.
    Frosch PJ, Pilz B, Burrows D, et al. Testing with fragrance mix: is the addition of sorbitan sesquioleate to the constituents useful? Contact Dermatitis 1995; 32: 266–72PubMedCrossRefGoogle Scholar
  23. 23.
    Johansen JD. Contact allergy to fragrances: clinical and experimental investigations of the fragrance mix and its ingredients. Contact Dermatitis 2002; 46 Suppl. 2: 1–31Google Scholar
  24. 24.
    Hjorth N. Skin reactions to balsams and perfumes: The Prosser-White Oration 1980. Clin Exp Dermatol 1982; 7: 1–9PubMedCrossRefGoogle Scholar
  25. 25.
    International Fragrance Association (IFRA). Recommendations concerning Peru balsam: code of practice. Geneva : IFRA, 1974a Oct, last amended Dec 1991Google Scholar
  26. 26.
    Hausen BM, Simatupang T, Bruhn G, et al. Identification of new allergenic constituents and proof of evidence for coniferyl benzoate in balsam of Peru. Am J Contact Dermat 1995; 6: 199–208CrossRefGoogle Scholar
  27. 27.
    Maouad M, Fleicher AB, Sherertz EF, et al. Significance-prevalence index number: a reinterpretation and enhancement of data from the North American Contact Dermatitis Group. J Am Acad Dermatol 1999; 41: 573–6PubMedGoogle Scholar
  28. 28.
    Johansen JD, Menné T, Christophersen J, et al. Changes in the sensitization pattern to common allergens in Denmark between 1985–86 and 1997–98, with a special view to the effect of preventive strategies. Br J Dermatol 2000; 142: 490–5PubMedCrossRefGoogle Scholar
  29. 29.
    Johansen JD, Rastogi SC, Menné T. Exposure to selected fragrance materials: a case study of fragrance mix positive eczema patients. Contact Dermat 1996; 34: 106–10CrossRefGoogle Scholar
  30. 30.
    Johansen JD, Rastogi SC, Menné T. Contact allergy to popular perfumes; assessed by patch test, use test and chemical analysis. Br J Dermatol 1996; 135: 419–22PubMedCrossRefGoogle Scholar
  31. 31.
    Rastogi SC, Johansen JD, Menné T. Natural ingredient based cosmetics: content of selected fragrance sensitizers. Contact Dermatitis 1996; 34: 423–6PubMedCrossRefGoogle Scholar
  32. 32.
    Rastogi SC, Johansen JD, Frosch PJ, et al. Deodorants on the European market: quantitative chemical analysis of 21 fragrances. Contact Dermatitis 1998; 38: 29–35PubMedCrossRefGoogle Scholar
  33. 33.
    Rastogi SC, Heydorn S, Johansen JD, et al. Fragrance chemicals in domestic and occupational products. Contact Dermatitis 2001; 45: 221–5PubMedCrossRefGoogle Scholar
  34. 34.
    Johansen JD, Andersen TF, Veien N, et al. Patch testing with markers of fragrance contact allergy: do clinical tests correspond to patients’ self-reported problems? Acta Derm Venereol (Stockh) 1997; 77: 149–53Google Scholar
  35. 35.
    de Groot AC, Liem DH, Nater JP, et al. Patch tests with fragrance materials and preservatives. Contact Dermatitis 1985; 12: 87–92PubMedCrossRefGoogle Scholar
  36. 36.
    Hannuksela M, Salo H. The repeated open application test (ROAT). Contact Dermatitis 1986; 14: 221–7PubMedCrossRefGoogle Scholar
  37. 37.
    Johansen JD, Andersen KE, Menné T. Quantitative aspects of isoeugenol contact allergy assessed by use and patch tests. Contact Dermatitis 1996; 34: 414–8PubMedCrossRefGoogle Scholar
  38. 38.
    Johansen JD, Andersen KE, Rastogi SC, et al. Threshold responses in cinnamic-aldehyde-sensitive subjects: results and methodological aspects. Contact Dermatitis 1996; 34: 165–71PubMedCrossRefGoogle Scholar
  39. 39.
    Andersen KE, Johansen JD, Bruze M, et al. The time-dose-response relationship for elicitation of contact dermatitis in isoeugenol allergic individuals. Toxicol Appl Pharmacol 2001; 170: 166–71PubMedCrossRefGoogle Scholar
  40. 40.
    Johansen JD, Bruze M, Andersen KE, et al. The repeated open application test: suggestions for a scale of evaluation. Contact Dermatitis 1997; 39: 95–6CrossRefGoogle Scholar
  41. 41.
    Schnuch A, Uter W, Geier J, et al. Epidemiology of contact allergy: an estimation of morbidity employing the clinical epidemiology and drug-utilization research (CE-DUR) approach. Contact Dermatitis 2002; 47: 32–9PubMedCrossRefGoogle Scholar
  42. 42.
    Seidenari S, Manzini M, Danese P, et al. Patch and prick test study of 593 healthy subjects. Contact Dermatitis 1990; 23: 162–7PubMedCrossRefGoogle Scholar
  43. 43.
    Barros MA, Baptista A, Correia TM, et al. Patch testing in children: a study of 562 school children. Contact Dermatitis 1991; 25: 156–9PubMedCrossRefGoogle Scholar
  44. 44.
    Mortz CG, Lauritsen JM, Bindslev-Jensen C, et al. Contact allergy and allergic contact dermatitis in adolescents: prevalence measures and associations. Acta Derm Venereol 2002; 82: 352–8PubMedCrossRefGoogle Scholar
  45. 45.
    Schäfer T, Böhler E, Ruhdofer S, et al. Epidemiology of contact allergy in adults. Allergy 2001; 56: 1192–6PubMedCrossRefGoogle Scholar
  46. 46.
    Schnuch A, Geier J, Uter W, et al. National rates and regional differences in sensitization to allergens of the standard series: population adjusted frequencies of sensitization (PAFS) in 40.000 patients from a multicentre study (IVDK). Contact Dermatitis 1997; 37: 200–9PubMedCrossRefGoogle Scholar
  47. 47.
    Johansen JD, Menné T. The fragrance mix and its constituents: a 14-year material. Contact Dermatitis 1995; 32: 18–23PubMedCrossRefGoogle Scholar
  48. 48.
    Basketter DA. Skin sensitization to cinnamic alcohol: the role of skin metabolism. Acta Derm Venerol (Stockh) 1992; 72: 264–5Google Scholar
  49. 49.
    Basketter DA, Allenby CF. Studies of the quenching phenomenon in delayed contact hypersensitivity reactions. Contact Dermatitis 1991; 25: 160–71PubMedCrossRefGoogle Scholar
  50. 50.
    Basketter DA. Quenching: fact or fiction? Contact Dermatitis 2000; 43: 253–8PubMedCrossRefGoogle Scholar
  51. 51.
    International Fragrance Association (IFRA). Guideline on the safe use of Isoeugenol: code of practice. Geneva: IFRA, 1980 May with amendments 1992 and 1998Google Scholar
  52. 52.
    White IR, Johansen JD, Arneau Giménez E, et al. Isoeugenol is an important contact allergen: can it be safely replaced with isoeugenyl acetate? Contact Dermatitis 1999; 41: 272–5PubMedCrossRefGoogle Scholar
  53. 53.
    Ehret C, Maupetit P, Petrzilka M, et al. Preparation of an oak moss absolute with a reduced potential. Int J Cosmet Sci 1992; 14: 121–30PubMedCrossRefGoogle Scholar
  54. 54.
    Actander S. Oak Moss: perfume and flavor materials of natural origin. Elisabeth (NJ): 1960, 456Google Scholar
  55. 55.
    Lepoittevin JP, Meschkat E, Huygens S, et al. Presence of resin acids in “Oakmoss” patch test material: a source of misdiagnosis? [letter to the editor]. J Invest Dermatol 2000; 115: 129–30PubMedCrossRefGoogle Scholar
  56. 56.
    Lepoittevin JP, Bernard G, Giménez Arneau E, et al. Development of a method for the identification of oak-moss sensitizers [abstract]. Contact Dermatitis 2002; 46 Suppl. 4 : 61Google Scholar
  57. 57.
    Berne B, Lundin AA, Malmros PE. Side effects of cosmetics and toiletries in relation to use: a retrospective study in a Swedish population: clinical report. Eur J Dermatol 1994; 4: 189–93Google Scholar
  58. 58.
    Fenn RS. Aroma chemical usage trends in modern perfumery. Perfumer & Flavorist 1989; 14: 1–12Google Scholar
  59. 59.
    International Fragrance Association (IFRA). Guideline on the safe use of hydroxycitronellal: code of practice. Geneva: IFRA, 1987 MarGoogle Scholar
  60. 60.
    Rastogi SC, Johansen JD, Menné T, et al. Contents of fragrance allergens in children’s cosmetics and cosmetic-toys. Contact Dermatitis 1999; 41: 84–8PubMedCrossRefGoogle Scholar
  61. 61.
    Johansen JD, Skov L, Volund A, et al. Allergens in combination have a synergetic effect on the elicitation response: a study of fragrance-sensitized individuals. Br J Dermatol 1998; 139: 264–70PubMedCrossRefGoogle Scholar
  62. 62.
    Adams RM, Maibach HI. A five-year study of cosmetic reactions. J Am Acad Dermatol 1985; 13: 1062–9PubMedCrossRefGoogle Scholar
  63. 63.
    DeGroot A. Contact allergy to cosmetics: causative ingredients. Contact Dermatitis 1987; 17: 26–34CrossRefGoogle Scholar
  64. 64.
    Rothenborg HW, Hjorth N. Allergy to perfumes from toilet soap and detergents in patients with dermatitis. Arch Dermatol 1968; 97: 417–21PubMedCrossRefGoogle Scholar
  65. 65.
    Hannuksela M, Kousa M, Pirilä V. Allergy to ingredients of vehicles. Contact Dermatitis 1976; 2: 105–10PubMedCrossRefGoogle Scholar
  66. 66.
    Bordalo O, Pereira F, Ferreira L, et al. Patch testing with commercial perfumes: abstract at the 5th Congress of the European Society of Contact Dermatitis. Contact Dermatitis 2000; 42: 15Google Scholar
  67. 67.
    Johansen JD, Rastogi SC, Bruze M, et al. Deodorants: a clinical provocation study in fragrance-sensitive individuals. Contact Dermatitis 1998; 39: 161–5PubMedCrossRefGoogle Scholar
  68. 68.
    Bruze M. Quantitative aspects of contact allergy to isoeugenol and cinnamic aldehyde in deodorants. Abstract at the 5th Congress of the European Society of Contact Dermatitis. Contact Dermatitis 2000; 42: 5CrossRefGoogle Scholar
  69. 69.
    Johansen JD, Rastogi SC, Andersen KE, et al. Content and reactivity to product perfumes in fragrance mix positive and negative eczema patients. Contact Dermatitis 1997; 36: 291–6PubMedCrossRefGoogle Scholar
  70. 70.
    von Peter C, Hoting E. Anwendungstest mit parfümierten Kosmetika bei Patienten mit positivem Epikutantest auf Duftsstoff-Mischung. Dermatosen 1993; 41: 237–41Google Scholar
  71. 71.
    Held E, Johansen JD, Agner T, et al. Contact allergy to cosmetics: testing with patients’ own products. Contact Dermatitis 1999; 41: 84–8Google Scholar
  72. 72.
    Malten KE, Ketel WG, Nater JP, et al. Reactions in selected patients to 22 fragrance materials. Contact Dermatitis 1984; 11: 1–10PubMedCrossRefGoogle Scholar
  73. 73.
    Friedmann PS. The immunology of allergic contact dermatitis: The DNBC story. Adv Dermatol 1990; 5: 175–96PubMedGoogle Scholar
  74. 74.
    Kligman AM. The identification of contact allergens by human assay: II. factors influencing the induction and measurement of allergic contact dermatitis. J Invest Dermatol 1966; 47: 375–92PubMedGoogle Scholar
  75. 75.
    Hannuksela M. Sensitivity of various skin sites in the repeated open application test. Am J Contact Dermat 1991; 2: 102–4Google Scholar
  76. 76.
    Hotchkiss SAM. Absorption of fragrance ingredients using in vitro models with human skin. In: Frosch PJ, Johansen JD, White IR, editors. Fragrances-beneficial and adverse effects. Berlin: Springer-Verlag, 1998: 125–35Google Scholar
  77. 77.
    Zachariae C, Held E, Johansen JD, et al. Effect of a moisturiser on skin susceptibility to Nicl2. Acta Derm Venereol 2002; 83: 93–7CrossRefGoogle Scholar
  78. 78.
    Warbrick EV, Dearman RJ, Basketter DA, et al. Influence of application vehicle on skin sensitization to methylchloroisothiazolinone/methylthiazolinone: an analysis using the local lymph node assay. Contact Dermatitis 1999; 41: 325–9PubMedCrossRefGoogle Scholar
  79. 79.
    Agner T, Johansen JD, Overgaard L, et al. Combined effects of irritants and allergens. Contact Dermatitis 2002; 47: 21–6PubMedCrossRefGoogle Scholar
  80. 80.
    Edman B. The influence of shaving method on perfume allergy. Contact Dermatitis 1994; 31: 291–2PubMedCrossRefGoogle Scholar
  81. 81.
    Allenby CF, Goodwin BFJ. Influence of detergent washing powders on minimal eliciting patch test concentrations of nickel and cobalt. Contact Dermatitis 1983; 9: 491PubMedCrossRefGoogle Scholar
  82. 82.
    Allenby CF, Basketter DA. An arm immersion model of compromised skin: influence on minimal eliciting patch test concentrations of nickel. Contact Dermatitis 1993; 28: 129PubMedCrossRefGoogle Scholar
  83. 83.
    Hindsén M, Bruze M, Christiansen OB. The significance of previous allergic contact dermatitis for elicitation of delayed hypersensitivity to nickel. Contact Dermatitis 1997; 37: 101–6PubMedCrossRefGoogle Scholar
  84. 84.
    Hindsén M, Bruze M. The significance of previous contact dermatitis for elicitation of contact allergy to nickel. Acta Derm Venereol 1998; 78: 367–70PubMedCrossRefGoogle Scholar
  85. 85.
    Scheinman PL. Exposing covert fragrance chemicals. Am J Contact Dermat 2001; 12: 225–8PubMedCrossRefGoogle Scholar
  86. 86.
    Scheinman PL. The foul side of fragrance-free products: what every clinician should know about managing patients with fragrance allergy. J Am Acad Dermatol 1999; 41: 1020–4PubMedCrossRefGoogle Scholar
  87. 87.
    Elsner P. What is the state of cosmetic labelling in Europe? Am J Contact Dermat 1993; 4: 198–200Google Scholar
  88. 88.
    White I. Fragrances -future aspects. In: Frosch PJ, Johansen JD, White IR, editors. Fragrances-beneficial and adverse effects. Berlin: Springer-Verlag, 1998: 216–23Google Scholar

Copyright information

© Adis Data Information BV 2003

Authors and Affiliations

  1. 1.Department of Dermatology, The National Allergy Research Centre, Gentofte HospitalUniversity of CopenhagenCopenhagenDenmark

Personalised recommendations