Allergen of the Year: Fragrance

Frances J. Storrs

Disclosures

Dermatitis. 2007;18(1):3-7. 

In This Article

Introduction

FRAGRANCE is Allergen of the Year for 2007! I applaud this choice because it provides a chance to review how allergic reactions to fragrance have been and will be diagnosed. We can also examine the issue of clinical relevance as it relates to the true prevalence of fragrance-induced allergic contact dermatitis.

There are more than 2,800 fragrance ingredients listed in the database of the Research Institute for Fragrance Materials, Inc. (RIFM). At least 100 of these ingredients are known allergens.[1] New chemicals are frequently introduced. Botanical ingredients used in fragrances can also cause allergic reactions but are not included in this commentary.[2]

Fragrances are complex substances. One perfume may contain hundreds of different chemicals. Trying to pinpoint specific fragrance allergens has challenged patch testers for years. The fragrance industry is both lucrative and competitive. The composition of a successful fragrance compound is an asset, which has led to a situation in which the fragrance industry is not always eager to disclose the chemicals it uses.

In the late 1970s, Walter G. Larsen became interested in persons who were allergic to fragrances. He was able to collect the ingredients of the perfume in Mycolog cream (Bristol-Myers Squibb, Princeton, NJ) and found eight patients who were allergic to one or more of the 28 components of this perfume.[3] Interestingly, all eight patients also reacted positively to ethylenediamine.

In 1977, Dr. Larsen evaluated 20 patients (5 were in the Mycolog group) who were "perfume sensitive."[4] He tested them with 30 chemicals he had obtained from RIFM; the North American Contact Dermatitis Group (NACDG) preservative, perfume (15 chemicals), and standard series; components of balsam of Peru; and a few other chemicals he had collected. The results of Dr. Larsen's testing, described in his 1977 article, are almost universally credited as the source of the composition of the fragrance mix that has been used internationally ever since to diagnose fragrance-allergic patients.[4]

In fact, the present mix does contain some but not all of the common allergens noted in the 1977 article. Jasmine synthetic (the most common reactor) was not included in the mix, nor was treemoss absolute. Instead, oakmoss absolute was included, and α-amyl cinnamic aldehyde (amyl cinnamal) was used instead of the alcohol.

Dr. Larsen told me recently that there is no one article that describes the creation of fragrance mix I (FM I). No one seems to know why or when the α-amyl cinnamic alcohol was changed to the aldehyde. No matter; the eight ingredients in the original fragrance mix have remained unchanged since the late 1970s save for the lowering of their total concentration from 16% to 8% in 1984. Sorbitan sesquioleate at 5% was added as a detergent along the way.[5] The eight ingredients of FM I, all at 1%, are as follows:

  1. Evernia prunastri (oak moss) extract

  2. Isoeugenol

  3. Eugenol

  4. Cinnamal

  5. Hydroxycitronellal

  6. Geraniol

  7. Cinnamyl alcohol

  8. Amyl cinnamal

In the late 1970s, Dr. Larsen gave several vials of the eight-component mix he had formulated to Dr. Jon Hanifin, who carried them on his sabbatical to Copenhagen, Denmark. Dr. Hanifin gave the vials to Dr. Niels Hjorth of Gentofte Hospital, who included them in the series of the International Contact Dermatitis Research Group. The rest is history!

Dr. Larsen's initial articles had seven and eight references, respectively. Recent reviews of fragrance reactions have had hundreds of references.[6] There is great interest in this subject.

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