Lanolin Allergy: History, Epidemiology, Responsible Allergens, and Management

Bailey Lee; Erin Warshaw


Dermatitis. 2008;19(2):63-72. 

In This Article

Patch Testing

When used “as is,” lanolin is thought to be a weak allergen. This raises concern that using pure lanolin in patch tests may produce many false-negative reactions.[1,28] Early dermatologists experimented with different methods, using lanolin, eucerin, and varying concentrations of wool alcohols with or without the addition of keratolytics.[1,26–28,66–68] Since the late 1960s, 30% wool alcohols have been advocated as the standard for patch testing.[32]

The use of more than one patch-testing substance for detecting lanolin allergy is important, and the use of AL-101 (100%) has been reported to cause fewer irritant reactions. Mortenson tested 899 patients undergoing patch testing with wool alcohols, hydrogenated lanolin, Eucerin, and AL-101. Of those tested, 6.7% were positive to at least one of these allergens; approximately half of these would have been missed if only wool alcohols had been used.[30] More evidence for the use of AL-101 in patch-testing came out of a 1997 Belgian study. Matthieu and Dockx reported two groups of patients with dermatitis who were tested with a standard series containing wool alcohols (30% pet) and AL-101 (100%). In the first group, 45 (11.5%) of 393 patients had positive reactions to wool alcohols or AL-101 (100%) or both: 32 reacted to only AL-101 (100%), 1 reacted to only wool alcohol, and 12 reacted to both. The second group was tested with wool alcohol (30% pet), AL-101 (100%), and AL-101 (50%). Of the 28 patients who reacted to at least one of these compounds, 9 reacted only to AL-101 (100%), 8 reacted only to AL-101 (50%), 5 reacted to both the 50% and 100% concentrations of AL-101, 1 reacted to only wool alcohol, and one reacted to both wool alcohol and AL-101 (100%) (results for the remaining 4 patients were not reported).[32]

In the 1989 Swedish study by Edman and Moller, 33 patients with previously reported positive patch-test reactions to wool alcohols, AL-101, or both were retested with wool alcohols (30% pet); AL-101 (as is); Ameralk (Amerchol), the alcoholic fraction of AL-101 (7% pet); white petrolatum; Decubal cream (Alpharma, Bridgewater, NJ) (as is); and Golden Fleece (Alpharma), a form of purified anhydrous lanolin found at a concentration of 6% in Decubal. Twenty-five percent of these patients would have been missed if only 30% wool alcohols or AL-101 had been used whereas only 10% would have been missed if both AL-101 and wool alcohols had been used. Of the six test substances used, Ameralk caused positive reactions in 85% of the 20 patients who had positive reactions to the lanolin products.[42] Currently, most patch-test experts use both 30% wool alcohols and AL-101 for the detection of lanolin allergy.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.