Allergen of the Year: Fragrance

Frances J. Storrs

Disclosures

Dermatitis. 2007;18(1):3-7. 

In This Article

Frequency of Fragrance Allergy

For many years, fragrance mix produced the fourth or fifth most frequent patch-test reaction seen by the NACDG. At present, patch-test reactions to fragrance mix are fourth in frequency (at an incidence of 10.4%), as compared with reactions to nickel (16.7%), neomycin (11.6%), balsam of Peru (11.6%), gold (10.2%), and quaternium-15 (9.3%).[7]

It is important to note that these data record the frequency of patch-test reactions, not allergic contact dermatitis caused by fragrances. Allergy is a disease (allergic contact dermatitis [ACD]) whereas a positive patch-test result is an allergic reaction. One may be allergic (ie, by patch testing) to gold or poison oak but seldom develop gold or poison oak ACD (allergy). Despite this important difference, many or even most articles about fragrances refer to the great frequency of "fragrance allergy" and imply that fragrances are associated with a good deal of clinical contact dermatitis. One such article noted that only 39% of the 8.5% of women reacting positively to fragrance mix had positive reactions to at least one constituent of the mix and that only 50% of the 6.7% of men reacting positively to fragrance mix had positive reactions to one constituent.[8] The article never discussed clinical disease or relevance. In short, articles about "fragrance allergy" are often no more than documentations of the frequency of patch-test reactions. In my opinion, the imprecise language used in this literature has led clinicians to believe that fragrance allergy (clinical ACD) is much more common than it really is.

It is not surprising that many people have positive patch-test reactions to fragrance mix, which contains constituents still widely used in ordinary fragrances found in cosmetics and household products. Five hundred sixty-two Scandinavian babies (ages 3-18 months) had no reproducible fragrance mix reactions, but we know that 1.7 to 4.1% of the general population and 10.4% of North American patients evaluated for ACD have positive reactions to fragrance mix.[1,7,9] Fragrance mix constituents are good allergens; thus, frequent exposures to them (like frequent exposures to thimerosal) are likely to cause sensitization and allergic patch-test reactions but not necessarily clinical allergy (ie, ACD).

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