Perfume allergy
Perfume is one of the commonest causes of allergic contact eczema. Although perfume allergy is seen most often in women, it can also affect men and teenagers.
What is perfume?
Perfume is a mixture of fragrances. These fragrances work together to give a characteristic scent. Fragrances are volatile and each fragrance evaporates at a different rate. This is why when you wear a perfume, the scent changes over time. A perfume can contain anything from 10 to 300 different ingredients and there are around 2500 different fragrances to choose from when making a perfume. Fragrances come from chemicals and from natural extracts, for example, from plants. Both chemical and natural fragrances can cause allergic reactions–most perfume allergies come from natural fragrances. Perfume is added to a wide range of consumer goods, for example, cosmetic and cleaning products, children’s toys, paper products and air fresheners; perfume is also used in industrial products, such as paint and soluble oils.
What causes perfume allergy?
Perfume allergy is the result of too many allergens, or allergy-causing fragrances, being added to a product. Of the possible 2500 fragrances used, about 100 are known to give an allergic reaction in humans. Of these, 25 fragrances are used frequently, of which 10–12 are used very frequently, in perfumes for a wide range of purposes. See the following table.
| Chemical analyses of the occurrence of 7 fragrance allergens in 3 types of perfume product |
|
Product
|
Number of
products tested
|
Proportion with one or
more of the 7 allergens
|
|
Prestige Perfume
|
10
|
100 %
|
|
Plant-based Perfume
|
22
|
82 %
|
| Deodorant |
72
|
17-76 %
|
|
| Reference: Rastogi SC. 1996; 1998; Johansen JD. 2002 |
Perfume products that have a prolonged contact with the skin, for example, perfume, eau de toilette, eau de cologne, deodorant, and creams and lotions, tend to give a higher risk of allergy than products that are in contact with the skin for a shorter period, for example, hair shampoo.
A study of five new commercial perfumes showed that they contained fewer perfume allergens compared with established products.
What are the symptoms of perfume allergy?
The first symptom of perfume allergy is often eczema in the armpits from using deodorant. In some cases the eczema will heal when use of the specific deodorant stops. In other cases the eczema persists, or heals to flare up again when other products are used that contain the allergen to which the person reacts. The eczema may be on the hands, face or other areas or the body.
Allergic reaction caused by perfume in deodorant
How widespread is perfume allergy?
Perfume is one of the commonest causes of allergic contact eczema. Although perfume allergy is seen most often in women, it can also affect men and teenagers. A study of schoolchildren from Odense (Denmark) showed that approximately 2% of the 12–16-year-olds were allergic to perfume. Recent studies from Germany suggest that approximately 4% of the adult population have perfume allergy, and several Danish studies point to a doubling of perfume allergy in Denmark since the early 1990s. This is due to an increasing use of perfume in a wide range of products combined with the fact that larger amounts of perfume are now used in the products, without the number of perfume allergens being regulated. Approximately 10% of eczema patients who have been patch-tested have perfume allergy.
Data from Germany indicate that the occurrence of perfume allergy has fallen among eczema patients who have been patch-tested from 13.1% in 1999 to 7.8% in 2002 (Schnuch 2004). This in line with chemical analyses showing the newer commercial perfumes to have fewer perfume allergens compared with established perfumes. This could be due to the new legislation that came into effect on 11 March 2005. Some requirements, however, have been followed since 1998 (see below). The situation in Denmark is being followed closely.
Diagnosis and treatment
Perfume allergy is diagnosed with a patch test, also called a plaster test. For the diagnosis, the dermatologist uses a mixture of 8 fragrances, 7 chemical substances, natural extracts, and a number of other fragrances, both individually and in combination. The mixture of the 8 fragrances is called a fragrance mix; it has been used since the early 1980s. This fragrance mix has recently been extended, leading to the fragrance mix II diagnostic test, which contains the six fragrances that most often give allergic reactions. When perfume allergy is suspected, eczema patients are tested with the patch test, often supplemented with their own cosmetics and perfumes etc.
Legislation
The ingredients in cosmetics, this also includes perfumes, are regulated by an EU directive. For Denmark this is in the form of a Danish declaration, the so-called cosmetics declaration.
Changes have been made to the EU directive and, consequently, also to the cosmetics declaration, making it mandatory for all fragrances to be included in a product’s list of ingredients. The new legislation came into effect on 11 March 2005. It led to the requirement that any of 26 fragrances known to provoke allergy, if present in the product, must be included in the product’s list of ingredients if they occur in an amount greater than a specified minimum amount.
The 26 fragrances are as follows:
| Name of fragrance (INCI) |
| Amyl cinnamal |
| Benzyl alcohol |
| Cinnamyl alcohol |
| Citral |
| Eugenol |
| Hydroxycitronellal |
| Isoeugenol |
| Amylcinnamyl alcohol |
| Benzyl salicylat |
| Cinnamal |
| Coumarin |
| Geraniol |
| Hydroxyisohexyl 3-cyclohexene carboxaldehyde |
| Anise alcohol |
| Benzyl cinnamate |
| Farnesol |
| Butylphenyl methylpropional |
| Linalool |
| Benzyl benzoate |
| Citronellol |
| Hexyl cinnamal |
| d-Limonene |
| Methyl 2-octynoate |
| Alpha isomethylionone |
| Evernia prunastri (egemos-ekstrakt) |
|
Evernia Furfuraceae (træmos-ekstrakt)
updated june 2007
|
The regulations state that if a product contains one of the fragrances listed above, the fragrance must be included in the list of ingredients if the concentration is more than 0.001% in products that remain on the skin, such as lotions and deodorants, and if the amount is more than 0.01% in products that are washed off the skin, such as hair shampoo.
From 8 October 2005 the regulations pertaining to the 26 fragrances listed above have also been applicable to detergents and cleaning agents, both for household and commercial use. The new regulations give dermatologists better possibilities to pinpoint perfume allergies and give those affected by perfume allergy the opportunity of knowing what products to avoid.
It should be noted, however, that it is not always possible to guard against perfume allergy. There are many perfume products and thousand of fragrances; and not all fragrances have been tested for allergy-causing substances. Also important is the fact that very small amounts of the listed fragrances are permitted in products without having to be included in the list of ingredients.
What can you do yourself?
For people without perfume allergy:
To avoid perfume allergy, use unperfumed products.
If you have eczema, do not use perfumed products. Eczema increases the risk of developing an allergy because the skin’s protective barrier is destroyed by the eczema.
For people with perfume allergy:
If you have severe perfume allergy or wish to fully guard against it, avoid using perfumed products.
The easiest way to find out if a product is perfumed is to smell it.
Remember that natural cosmetics and other natural products also contain fragrances that cause allergic reactions.
If you wish to use a perfume product, read the list of ingredients to check that the product does not contain a fragrance that will give you an allergic reaction.
Some perfume products, such as eau de toilette, can be sprayed on clothing instead of the skin. Providing you do not have severe perfume allergy, you may be able to use certain perfumed products, particularly those that are washed off and therefore have only limited contact with the skin.
If you develop a rash from using a product, you should immediate stop using it. If the rash spreads or worsens, you should consult a doctor.
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Scientific publications
Johansen JD. Contact Allergy to Fragrances: Clinical and experimental investigations of the fragrance mix and its ingredients. Doktordisputats fra Københavns Universitet. Contact Dermatitis 2002:46 (suppl. 3): 1-31
Mørtz CG. The prevalence of atopic dermatitis, hand eczema, allergic contact dermatitis, type IV and type I sensitization in 8th grade school children in Odense. Ph.d. afhandling fra Syddansk Universitet 1999.
Nielsen NH et al. Allergic contact sensitization in an adult Danish population: two cross sectional surveys eight years apart (The Copenhagen Allergy Study). Acta Derm Venereol 2001;81:31-34.
Rastogi SC et al. Natural ingredient-based cosmetics. Content of selected fragrance sensitizers. Contact Dermatitis 1996:34:423-26.
Rastogi SC et al. Deodorants on the European Market: quantitative chemical analysis of 21 fragrances. Contact Dermatitis 1998:38: 29-35
Rastogi SC et al. The composition of fine fragrances is changing. Contact Dermatitis 2003:48:130-2
Schnuch A et al. Epidemiology of contact allergy: an estimation of morbidity employing the clinical epidemiology and drug utilization research (CE-DUR) approach. Contact Dermatitis 2002:47:32-9.
Schnuch A et al. Contact allergy to fragrances: frequencies of sensitization from 1996 to 2002. Results of the IVDK. Contact Dermatitis 2004:50:65-76
Schnuch A et al. Sensitization to 26 fragrances to be labelled according to EU regulations. Contact Dermatitis 2007:57:1-10
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