The frequency of fragrance allergy in a patch-test population over a 17-year period

Microbial Colonization, Biofilm Formation, and Malodour of Washing Machine Surfaces and Fabrics and the Evolution of Detergents in Response to Consumer Demands and Environmental Concerns

Bacterial attachment and biofilm formation are associated with the contamination and fouling at several locations in a washing machine, which is a particularly complex environment made from a range of metal, polymer, and rubber components. Microorganisms also adhere to different types of clothing fibres during the laundering process as well as a range of sweat, skin particles, and other components. This can result in fouling of both washing machine surfaces and clothes and the production of malodours. This review gives an introduction into washing machine use and surfaces and discusses how biofilm production confers survival properties to the microorganisms. Microbial growth on washing machines and textiles is also discussed, as is their potential to produce volatiles. Changes in consumer attitudes with an emphasis on laundering and an overview regarding changes that have occurred in laundry habits are reviewed. Since it has been suggested that such changes have increased the risk of microorganisms surviving the laundering process, an understanding of the interactions of the microorganisms with the surface components alongside the production of sustainable detergents to meet consumer demands are needed to enhance the efficacy of new antimicrobial cleaning agents in these complex and dynamic environments.

Contact allergy to fragrance mix I and its components in individuals with photocontact allergy to ketoprofen

BACKGROUND

Contact allergy to fragrance mix I (FM I) is over-represented in patients photoallergic to ketoprofen. The prevalence of contact allergy to two components of FM I, cinnamal and cinnamyl alcohol, in ketoprofen-photoallergic patients is higher than in dermatitis patients.

OBJECTIVE

To explore the prevalence of contact allergy to FM I and its individual components in patients with photocontact allergy to ketoprofen, and to compare with a dermatitis and the general population.

METHODS

Data on patch and photopatch tests performed between 2009-2018 were collected. Ketoprofen-photoallergic patients were compared with dermatitis patients and published data on the general population regarding the prevalence and the distribution of contact allergy to FM I and its components.

RESULTS

A higher prevalence of contact allergy to cinnamyl alcohol compared with cinnamal (23.3% vs 10.0%), and eugenol compared with isoeugenol (23.3% vs 6.7%), was observed in ketoprofen-photoallergic patients, while the relationship was the opposite in the dermatitis group (0.7% vs 1.05%; 0.4% vs 0.9%). The overall prevalence of contact allergy to several components of FM I was significantly higher in ketoprofen-photoallergic patients.

CONCLUSIONS

Contact allergy to FM I and many of its components is over-represented in patients photoallergic to ketoprofen compared with dermatitis patients and the general population.

Update on Contact Sensitization in the Older Adult Population

BACKGROUND

Little is known about the epidemiology of allergic contact dermatitis in the aging US population.

OBJECTIVE

The aim of this study was to describe patch test results in a cohort of older adult patients evaluated in a patch testing clinic in a tertiary medical center.

METHODS

This study was a retrospective analysis of patch test results of adults 65 years and older from February 2013 to December 2019.

RESULTS

Data from a total of 169 patients 65 years and older were analyzed. Of these patients, 84.6% (143/169) had 1 or more positive reactions on patch testing, 84.6% (121/143) of which were felt to be clinically relevant and received a final diagnosis of allergic contact dermatitis. The most common allergen categories were fragrances (30.1%), preservatives (20.8%), metals (11.0%), medicaments (8.3%), and textile dyes (6.5%). The most common individual allergens were Myroxylon pereirae resin (balsam of Peru), hydroperoxide of linalool, methylisothiazolinone, nickel sulfate, and fragrance mix I. Personal products were by far the most common presumed source of allergen exposure.

CONCLUSIONS

Allergic contact dermatitis is a common diagnosis in the older adult population, and patch testing with allergen avoidance counseling can be an important diagnostic step and potential cure for this allergic condition.

Skin exposure to scented products used in daily life and fragrance contact allergy in the European general population - The EDEN Fragrance Study

BACKGROUND

Fragrances are widely used in scented products used in daily life with the potential to induce skin sensitization.

OBJECTIVE

To evaluate exposure to scented products and to explore associations between exposure and fragrance contact allergy.

METHODS

A cross-sectional study on individuals from 18 to 74 years of age, who were randomly selected from the general population in five European countries. A random sample (N = 3119) was patch tested and interviewed on exposure to scented products.

RESULTS

Female participants were strongly associated with exposure to scented products relative to male participants. Participants age 40 years and older showed an inverse association with exposure to scented products. Compared to Sweden, The Netherlands followed by Germany showed the highest overall exposure to scented products. Sensitive skin was associated with exposure to scented products and with fragrance allergy. In univariable regression analysis, exposure to leave-on products and to specific scented product subgroups was significantly associated with fragrance allergy.

CONCLUSION

Exposure to scented products depends primarily on sex and age. Female sex and sensitive skin are relevant indicators for developing fragrance allergy. Because aggregate exposure, especially to scented leave-on products, may enhance the prevalence of contact allergy to fragrances, further investigations into exposure amounts and frequencies is warranted.

Allergic Contact Dermatitis to Fragrances

Allergic contact dermatitis to fragrance is common. The prevalence of fragrance allergy in the general population is between 0.7% and 2.6%. In patch-test populations, the positive reaction rate to fragrances ranges from 5% to 11%. The most common fragrance screeners in most baseline series include fragrance mix 1, fragrance mix 2, and Balsam of Peru. The addition of hydroxyisohexyl 3-cyclohexene carboxaldehyde, hydroperoxides of limonene, and hydroperoxides of linalool to screening series can further aid in the diagnosis of fragrance allergy. In the proper clinical setting, supplemental patch testing with an additional fragrance or essential oil series should be considered.

Nipple and Areolar Eczema in the Breastfeeding Woman

Eczema of the nipple and areola can occasionally develop in the breastfeeding patient and is associated with sore, burning, and painful areolae and nipples. Management includes elimination of any precipitating allergens and irritants and the judicious use of appropriate topical corticosteroid preparations. Patients must also be offered effective pain control and support. The proper diagnosis and management of eczema of the nipple and areola in breastfeeding patients will prevent premature and iatrogenic weaning.

Skin sensitization

Skin sensitization associated with allergic contact dermatitis is a common health problem and is an important consideration for toxicologists in safety assessment. Historically, in vivo predictive tests have been used with good success to identify substances that have the potential to induce skin sensitization, and these tests formed the basis of safety evaluation. These original tests are now being replaced gradually either by in vitro assays or by further refinements of in vivo methods such as the local lymph node assay. Human data have also been available to inform classification decisions for some substances and have been used by risk managers to introduce measures for exposure reduction. However, humans encounter hazards in the context of exposure rather than in the form of intrinsic hazards per se, and so in this article, we have examined critically the extent to which human data have been used to refine classification decisions and safety evaluations. We have also evaluated information on the burden of human allergic skin disease and used this to address the question of whether, and to what extent, the identification and evaluation of skin sensitization hazards has led to an improvement of public and/or occupational health.

Irritant contact dermatitis risk of common topical traditional chinese medicines used for skin-lightening: a pilot clinical trial with 30 volunteers

Topical traditional Chinese medicine- (TTCM-) related contact dermatitis is not uncommon but ignored. Patch and photopatch tests using 6 individual herbal ingredients and Bai-Zhi-Kao (BZK; 白芷膏), a skin-lightening TTCM preparation, were conducted on 30 participants. Twenty-five subjects showed at least 1 positive reaction, including 6 (20.0%) participants who reacted to BZK. The majority reacted to Radix Ampelopsis japonica (Bai-Lian; 白蘞) (60.0%), whereas few reacted to Rhizoma Bletilla striata (Bai-Ji; 白芨) (16.7%), Rhizoma Atractylodis macrocephalae (Bai-Zhu; 白朮) (10.0%), Radix Angelicae dahuricae (Bai-Zhi; 白芷) (3.3%), and Herba asari (Xi-Xin; 細辛) (3.3%). In the photopatch test, 3 participants (10.0%) reacted positively to BZK and 10 to ≥1 constituent; however, all reacted to Radix Angelicae dahuricae (26.7%), Radix Ampelopsis japonica (13.3%), and Rhizoma Bletilla striata (3.3%). In contrast, no subjects showed positive reactions to Sclerotium Poria cocos (Bai-Fu-Ling; 白茯苓). Thus, BZK and its constituents might present potential latent risk of contact dermatitis owing to the possible presence of Radix Ampelopsis japonica and Radix Angelicae dahuricae. Furthermore, TTCMs, particularly cosmetic products, must be used carefully, with ample warning of potential contact dermatitis risk.

Dermatoses of the breast in lactation

Dermatoses of the breast during lactation can be difficult to diagnose because of their overlapping clinical appearances. It is important to properly diagnose and treat nipple dermatitis since it can be a significant source of pain when nursing. Poorly controlled nipple pain in nursing mothers is one of the primary reasons for breastfeeding to be discontinued earlier than is recommended. Therefore, it is relevant for practicing dermatologists to be aware of certain facts in a patient's history, specific physical exam findings, and the most appropriate laboratory tests used to diagnose these conditions. In addition, the therapeutic approach should be effective and safe for the mother and infant. This review article provides dermatologists with a detailed discussion on the clinical features and management of various breast dermatoses seen in lactation, including atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, psoriasis, bacterial infections, yeast infections and herpes simplex virus infections.

An immune response study of oakmoss absolute and its constituents atranol and chloroatranol

BACKGROUND

Atranol and chloroatranol are the main allergens of oakmoss absolute. However, the immune responses induced by these substances are poorly characterized.

OBJECTIVES

To characterize immune responses induced by atranol, chloroatranol and oakmoss absolute in mice.

METHODS

Mice were sensitized and challenged with various concentrations of atranol, chloroatranol, and oakmoss absolute. The immune responses were analysed as B cell infiltration, T cell proliferation in the draining lymph nodes, and expression of interleukin (IL)-18, IL-1β and tumour necrosis factor-α in skin. The cytotoxicity of atranol and chloroatranol against keratinocytes was determined.

RESULTS

Sensitization experiments showed that atranol, chloroatranol and oakmoss induced sensitization when applied in high concentrations. Challenge experiments showed that even low concentrations of atranol and chloroatranol induced sensitization. In parallel, atranol and chloroatranol elicited challenge reactions following sensitization with oakmoss. The magnitude of the immune response to the three allergens increased in the following order: atranol, chloroatranol, and oakmoss. The expression of proinflammatory cytokines was induced by chloroatranol and oakmoss, but not by atranol. Chloroatranol was found to be more cytotoxic than atranol against keratinocytes.

CONCLUSIONS

Atranol and chloroatranol can elicit both sensitization and challenge reactions, but the mixture of allergens in oakmoss absolute is more potent than atranol and chloroatranol alone.

Fragrance materials in asthma: a pilot study using a surrogate aerosol product

OBJECTIVE

Many household products contain fragrances. Little is known about exposure to fragrances on human health, particularly within the airways. This study aimed to evaluate how common household fragrance products (i.e. air fresheners, cleaning products) affect people with asthma, who frequently report sensitivity to these products. Many of these products have volatile organic compounds or semi-volatile organic compounds. This study evaluated nine fragrance materials in an aerosol formulation to assess effects on airway physiology, airway inflammation and symptom perception in normal controls and those with asthma.

METHODS

The effects of fragrances were evaluated in people without asthma, people with mild asthma and people with moderate asthma in a four-way crossover placebo-controlled study. Subjects were exposed twice to a fragranced aerosol and twice to a placebo aerosol (15 and 30 min each). Subjects completed a questionnaire for 29 symptoms during and up to 3 h after each exposure scenario. Spirometry was performed prior to and 3 h post-exposure; sputum induction was conducted 3 h post-exposure.

RESULTS

Nasal symptoms showed the greatest frequency of response in all three subject groups, and moderate asthmatics reported the greatest symptom severity and symptom types. No significant differences were noted in physiology or cellular inflammation.

CONCLUSION

A trend for increased symptoms was noted in moderate asthmatics, suggesting that asthma severity may play a factor in fragrance sensitivity.

Caring for new mothers: diagnosis, management and treatment of nipple dermatitis in breastfeeding mothers

Breastfeeding is thought to be the most optimal form of infant nutrition. Nursing mothers are generally advised to continue breastfeeding until the infant is two years of age or beyond. Unfortunately, however, a majority of nursing mothers will discontinue breastfeeding much earlier than recommended. The most common reason for early discontinuation of breastfeeding is nipple pain. It is, therefore, essential that dermatologists know how to appropriately diagnose and effectively treat nipple pain associated with nipple dermatitis among nursing mothers. This review article provides a detailed discussion on the clinical features and management of various causes of nipple dermatitis during lactation, including problems with infant latch-on, congenital oral anomalies, plugged lactiferous ducts, atopic dermatitis, irritant contact dermatitis, allergic contact dermatitis, yeast infections, bacterial infections, herpes simplex virus, and Raynaud's phenomenon of the nipple.

Vehicle effects on skin sensitizing potency of four chemicals: assessment using the local lymph node assay

The murine local lymph node assay (LLNA) can be used to determine the relative skin sensitizing potency of chemicals via interpolation of the quantitative dose response data generated. Using this approach we have demonstrated previously that the vehicle matrix in which a chemical allergen is encountered on the skin can have a significant influence on sensitizing potency. Estimates of relative potency are calculated from LLNA dose responses as a function of the mathematically derived EC3 value, this being the concentration estimated to induce a stimulation index (SI) of 3. To investigate further the influence of application vehicle on sensitizing potency, the LLNA has been used to examine the activity of four recognized human contact allergens: isoeugenol and cinnamic aldehyde, two fragrance chemicals; 3-dimethylaminopropylamine (a sensitizing impurity of cocamidopropyl betaine, a surfactant used in shower gel) and dibromodicyanobutane (the sensitizing component of Euxyl K 400, a preservative used in cosmetics). The four chemicals were applied in each of seven different vehicles (acetone: olive oil [4 : 1]; dimethylsulphoxide; methylethylketone; dimethyl formamide; propylene glycol; and both 50 : 50 and 90 : 10 mixtures of ethanol and water). It was found that the vehicle in which a chemical is presented to the epidermis can have a marked effect on sensitizing activity. EC3 values ranged from 0.9 to 4.9% for isoeugenol, from 0.5 to 1.7% for cinnamic aldehyde, from 1.7 to > 10% for dimethylaminopropylamine and from 0.4 to 6.4% for dibromodicyanobutane. These data confirm that the vehicle in which a chemical is encountered on the skin has an important influence on the relative skin sensitizing potency of chemicals and may have a significant impact on the acquisition of allergic contact dermatitis. The data also demonstrate the utility of the LLNA as a method for the prediction of these effects and thus for the development of more accurate risk assessments.

Skin sensitization, false positives and false negatives: experience with guinea pig assays

The advent of the local lymph node assay (LLNA), and efforts to develop in vitro alternatives for the identification of skin sensitizing chemicals has focused attention on the issue of false positive and false negative results. In essence, the question becomes 'what is the gold standard?' In this context, attention has focused primarily on the LLNA as this is now the preferred assay for skin sensitization testing. However, for many years prior to introduction of the LLNA, the guinea pig maximization test and the occluded patch test of Buehler were the methods of choice. In order to encourage a more informed dialogue about the relative performance, accuracy and applicability of the LLNA and guinea pig tests, we have here considered the extent to which guinea pig methods were themselves subject to false positives and negative results. We describe and discuss here well-characterized examples of instances where both false negatives (including abietic acid and eugenol) or false positives (including vanillin and sulfanilic acid) have been recorded in guinea pig tests. These and other examples are discussed with particular reference to the fabrication of a gold standard dataset that is required for the validation of in vitro alternatives.

Comparison of Marketed Cosmetic Products Constituents with the Antigens Included in Cosmetic-related Patch Test

BACKGROUND

Currently, cosmetic series (Chemotechnique Diagnostics, Sweden) is the most widely used cosmetic-related patch test in Korea. However, no studies have been conducted on how accurately it reflects the constituents of the cosmetics in Korea.

OBJECTIVE

We surveyed the constituents of various cosmetics and compare with the cosmetic series, to investigate whether it is accurate in determining allergic contact dermatitis caused by cosmetics sold in Korea.

METHODS

Cosmetics were classified into 11 categories and the survey was conducted on the constituents of 55 cosmetics, with 5 cosmetics in each category. The surveyed constituents were classified by chemical function and compared with the antigens of cosmetic series.

RESULTS

155 constituents were found in 55 cosmetics, and 74 (47.7%) of constituents were included as antigen. Among them, only 20 constituents (27.0%) were included in cosmetic series. A significant number of constituents, such as fragrance, vehicle and surfactant were not included. Only 41.7% of antigens in cosmetic series were found to be in the cosmetics sampled.

CONCLUSION

The constituents not included in the patch test but possess antigenicity are widely used in cosmetics. Therefore, the patch test should be modified to reflect ingredients in the marketed products that may stimulate allergies.

Trends of contact allergy to fragrance mix I and Myroxylon pereirae among Danish eczema patients tested between 1985 and 2007

BACKGROUND

Fragrance contact allergy has for long been recognized as an important health issue. In Denmark, the frequency of fragrance mix (FM) I contact allergy increased between 1985-1986 and 1997-1998 among male and female dermatitis patients.

OBJECTIVES

To investigate the development of FM I and Myroxylon pereirae (MP) contact allergy between 1985 and 2007 with an emphasis on recent years.

METHODS

A retrospective analysis of all patch test data from our database was performed. Comparison of sensitivity rates was made using a chi-squared test for trend. Logistic regression analyses were used to test for associations.

RESULTS

Of 16,173 patients, 7.2% were sensitized to FM I and 4% to MP. FM I contact allergy was associated with female sex [odds ratio (OR) = 1.52; 95% confidence interval (CI) = 1.33-1.74] and age between 41 and 60 years (OR = 3.20; 95% CI = 1.98-5.21). Significant declines of FM I and MP reactions among women but not men were observed between 1999 and 2007.

CONCLUSIONS

Although the frequency of FM I contact allergy has decreased in Denmark in recent years, it is still high. Furthermore, fragrance contact allergy is caused by other important allergens not included in this analysis. Allergic contact reactions to the ingredients of FM I remain a problem in European consumers.

Atopy and contact allergy to fragrance: allergic reactions to the fragrance mix I (the Larsen mix)

BACKGROUND

The relationship between an atopic diathesis and contact sensitization to fragrances is unclear.

OBJECTIVE

To investigate whether there is an association between atopy and allergy to fragrance mix I (FM I).

PATIENTS/METHODS

The computerized files of patients patch tested to FM I at St John's Institute of Dermatology (1980-2004) were reviewed. Demographic details recorded for all patch-tested patients included age, sex, date of testing, history of current or previous atopic eczema (AE), history of current or previous asthma nor hay fever (A/HF), family history (FH) of any type of atopy, and any positive patch tests.

RESULTS

About 8.4% of females (1713/20 338) and 6.6% of males (903/13 734) were allergic to FM I. About 8.95% (101/1129) of females with AE were allergic to FM I versus 8.63% (619/7171) of females who had neither AE and A/HF nor FH (non-atopics) (P = 0.72). About 5.6% (40/710) of males with AE were positive to FM I versus 6.9% (427/6201) of male non-atopics (P = 0.23). There was a striking increase in AE and A/HF during this 25-year period (P < 0.0001).

CONCLUSIONS

We found no association between atopy and allergy to FM I. There has been a marked increase in atopy in individuals referred for patch testing in the past 25 years.

Frequency of and trends in fragrance allergy over a 15-year period

BACKGROUND

The widespread use of fragrance-containing products is probably the most important reason for its high impact in allergic contact dermatitis.

OBJECTIVES

To describe the frequency of contact allergy to fragrance allergens as tested in the standard series, in relation to age, sex and lesion locations. To determine trends in frequency over the years and to study the association between positive tests observed with the different fragrance-allergy markers as well as between specific fragrance allergens and locations of the lesions.

PATIENTS/METHODS

10 128 patients underwent patch testing between January 1990 and December 2005 at the Dermatology department in Leuven.

RESULTS

1463 (14.5%), that is, 380 (26%) males and 1083 (74%) females, reacted positively to at least 1 fragrance-allergy marker in the standard series: 9% to fragrance mix I, 6% to Myroxylon pereirae, and 4.8% to colophonium (often in association), 2.1% to hydroxyisohexyl 3-cyclohexene carboxaldehyde and 2.1% to fragrance mix II, the latter 2 allergens having been introduced more recently. Over the years, fragrance contact allergy has shown a fluctuating trend. Hands and face were the most commonly affected body sites. Moreover, a significant association was found between specific fragrance allergens and certain locations.

CONCLUSIONS

This study illustrates that fragrance contact allergy is common in patients suffering from contact dermatitis.

Prevalence of patch test results from 1970 to 2002 in a multi-centre population in North America (NACDG)

BACKGROUND

The North American Contact Dermatitis Group (NACDG) has members who assess subjects with suspected allergic contact dermatitis (ACD) and patch tests them with the same screening allergens using a standardized procedure permitting analysis of long-term trends in patch test reactions.

OBJECTIVE

This study reports the trends in prevalence patch test positivity of allergens by pooling data collected by the NACDG between 1970 and 2002.

PATIENTS/METHODS

Patients were tested with the screening series of allergens, using a standardized technique. Data from these patients were recorded on a standard computer entry form and analysed. More than 100 allergens were tested on over 34,000 patients during several patch studies between the period. The Cochran-Armitage test of trend is used to evaluate changes in prevalence over time.

RESULTS

4 trends are noticed: (1) The incidence of presumed allergic nickel (P < 0.0001) and quaternium-15 (P < 0.0001) reactions rose with consistency over the years. (2) While that of cinnamic aldehyde (P = 0.21) and p-phenylenediamine (P < 0.0001) decreased. (3) The prevalence of positive reactions for potassium dichromate (P < 0.0001) shows an initial steady decrease but then a sharp increase starting from the 1996 period. (4) In contrast, thiuram (P = 0.0008) and neomycin (P < 0.0001) show an initial general increase, with a sharp decrease between 1998 and 2002.

CONCLUSION

Implications for opportunities to prevent ACD by utilizing less-allergenic alternatives appear robust; however, we do not wish to over generalize interpretations because of important limitations.

Frequency of allergic contact dermatitis to isoeugenol is increasing: a review of 3636 patients tested from 2001 to 2005

BACKGROUND

Isoeugenol is an important fragrance allergen. The cosmetic industry was recommended voluntarily to reduce concentrations of isoeugenol in finished cosmetic products from 0.2% to 0.02% in 1998. It was suspected that this would reduce the incidence of patch test positivity in individuals undergoing routine patch testing after approximately 2-3 years (the Dillarstone effect).

OBJECTIVES

To review our patch test data since the change in practice by industry, to see if there has been an observable decrease in isoeugenol contact sensitivity.

METHODS

We retrospectively analysed all subjects patch tested to isoeugenol 1% pet. in the St John's Department of Cutaneous Allergy over a period of 5 years, commencing 3 years after the changes.

RESULTS

We identified 3636 subjects, 97 of whom were positive for isoeugenol. Year-on-year incidence shows an increasing trend, with an overall incidence of 2.67%. Using the exact Cochran-Armitage test, this ascending trend is statistically significant (P = 0.0182). Seventy-two of 97 isoeugenol-positive subjects were also positive to fragrance mix I. Other fragrances positive in these 97 patients included Myroxylon pereirae (30%), Evernia prunastri (22%) and eugenol (15%).

CONCLUSIONS

We suspect that the increasing trend may be due to allergen substitution with compounds chemically related to isoeugenol, or which hydrolyse to isoeugenol itself.

Fragrance ingredient labelling in products on sale in the U.K

BACKGROUND

The seventh amendment of the European Union (EU) Cosmetics Directive (March 2005) and the Detergents Regulations of the EU (October 2005) are now legal requirements in Europe. Cosmetic products and detergents must be labelled for 26 individual named fragrances, when present at concentrations of > 10 parts per million (p.p.m.) in leave-on products and > 100 p.p.m. in rinse-off products.

OBJECTIVES

To make an assessment of the exposure pattern to fragrance of the U.K. consumer and to determine the frequency with which the constituent fragrances of fragrance mix I (FM I) and fragrance mix II (FM II) are included in products currently sold in the U.K.

METHODS

A study of perfumed cosmetic and household products available on the shelves of U.K. retailers was carried out in January 2006. Products were included if 'parfum' or 'aroma' was listed among the ingredients. Three hundred products were surveyed and any of the 26 listed fragrances named on the label were recorded.

RESULTS

The top six most frequently labelled fragrances were linalool (190; 63%), limonene (189; 63%), citronellol (145; 48%), geraniol (126; 42%), butyl phenyl methyl propional (Lilial(trade mark)) (126; 42%) and hexyl cinnamal (125; (42%). One of these, geraniol, is present in FM I and two others, citronellol and hexyl cinnamal, in FM II, thus tested as part of the British Standard patch test series. The frequencies of other constituents of FM I were as follows: eugenol, 80 (27%); hydroxycitronellal, 52 (17%); isoeugenol, 27 (9%); cinnamic alcohol, 25 (8%); amyl cinnamal, 22 (7%); cinnamal, 17 (6%); Evernia prunastri (oak moss absolute), 13 (4%). The other constituents of FM II occurred as follows: coumarin, 90 (30%); hydroxyisohexyl-3-cyclohexene carboxaldehyde (Lyral(trade mark)), 88 (29%); citral, 74 (25%); farnesol, 23 (8%). Linalool (n = 46; 66%) was the most frequently found fragrance in 70 personal care products (soap, shampoo, shower gel). Linalool (n = 47; 80%) and limonene (n = 45; 76%) were the most frequent in 59 products for men (e.g. aftershave). Limonene (n = 29; 51%) predominated in 57 household products (washing-up liquid, detergent). Limonene (n = 43; 98%) and linalool (n = 42; 95%) were the most frequent fragrances in 44 perfumes for women. Alpha-isomethyl ionone (n = 28; 72%) was the most frequent in 39 cosmetics (foundation, lipstick, etc). Citronellol predominated (n = 15; 88%) in 17 deodorants and limonene (n = 9; 64%) was the commonest in 14 dental products (toothpaste and mouthwash). Thirty-four products (11%) contained none of the listed fragrances but were labelled as containing 'parfum' or 'aroma'.

CONCLUSIONS

There is ongoing consumer exposure to the most frequent sensitizers in FM I: E. prunastri, isoeugenol and the cinnamon fragrances cinnamal and cinnamic alcohol. Hydroxyisohexyl-3-cyclohexene carboxaldehyde (Lyral(trade mark)) is present at significant concentrations in almost one-third of products. Linalool and limonene, fragrance terpenes which are significant allergens in their oxidized state, are the most frequent fragrances encountered by individuals living in the U.K. The current exposure pattern of the U.K. consumer suggests that we should add oxidized limonene and oxidized linalool to the test series for patients suspected to have fragrance allergy.

Sensitization to 26 fragrances to be labelled according to current European regulation

To study the frequency of sensitization to 26 fragrances to be labelled according to current European regulation. During 4 periods of 6 months, from 1 January 2003 to 31 December 2004, 26 fragrances were patch tested additionally to the standard series in a total of 21 325 patients; the number of patients tested with each of the fragrances ranged from 1658 to 4238. Hydroxymethylpentylcyclohexene carboxaldehyde (HMPCC) was tested throughout all periods. The following frequencies of sensitization (rates in %, standardized for sex and age) were observed: tree moss (2.4%), HMPCC (2.3), oak moss (2.0), hydroxycitronellal (1.3), isoeugenol (1.1), cinnamic aldehyde (1.0), farnesol (0.9), cinnamic alcohol (0.6), citral (0.6), citronellol (0.5), geraniol (0.4), eugenol (0.4), coumarin (0.4), lilial (0.3), amyl-cinnamic alcohol (0.3), benzyl cinnamate (0.3), benzyl alcohol (0.3), linalool (0.2), methylheptin carbonate (0.2), amyl-cinnamic aldehyde (0.1), hexyl-cinnamic aldehyde (0.1), limonene (0.1), benzyl salicylate (0.1), gamma-methylionon (0.1), benzyl benzoate (0.0), anisyl alcohol (0.0). 1) Substances with higher sensitization frequencies were characterized by a considerable number of '++/+++' reactions. 2) Substances with low sensitization frequencies were characterized by a high number of doubtful/irritant and a low number of stronger (++/+++) reactions. 3) There are obviously fragrances among the 26 which are, with regard to contact allergy, of great, others of minor, and some of no importance at all.

Fragrance allergy: assessing the risk from washed fabrics

The prevalence of contact allergy to fragrance ingredients increased during the last part of the 20th century with the consequence that a substantial number of individuals are at risk of experiencing allergic contact dermatitis (ACD) if they have a sufficient degree of skin exposure to the chemical to which they have become sensitized. Such exposure does not necessarily have to arise from the type of source that originally induced the sensitization. A number of sources of exposure are clearly associated with risk of elicitation of ACD, but the role of fragrance deposited on fabrics, for example as a result of laundry processes, also can be questioned. In this article, firstly, the risk of the induction of fragrance-related ACD from exposure to fragrance via fabric is considered. Using a quantitative risk-assessment approach, the risk appears to be extremely low. The possibility that fragrance residues on laundered fabrics might elicit reactions in those already sensitized by a different route is also discussed. Clinically, clothing pattern dermatitis associated with fragrance allergy is almost never observed, although this could be investigated clinically by exposing sensitized individuals to the relevant fragrance allergen.

Comparison of elicitation potential of chloroatranol and atranol - 2 allergens in oak moss absolute

Chloroatranol and atranol are degradation products of chloroatranorin and atranorin, respectively, and have recently been identified as important contact allergens in the natural fragrance extract, oak moss absolute. Oak moss absolute is widely used in perfumery and is the cause of many cases of fragrance allergic contact dermatitis. Chloroatranol elicits reactions at very low levels of exposure. In oak moss absolute, chloroatranol and atranol are present together and both may contribute to the allergenicity and eliciting capacity of the natural extract. In this study, 10 eczema patients with known sensitization to chloroatranol and oak moss absolute were tested simultaneously to a serial dilution of chloroatranol and atranol in ethanol, in equimolar concentrations (0.0034-1072 microM). Dose-response curves were estimated and analysed by logistic regression. The estimated difference in elicitation potency of chloroatranol relative to atranol based on testing with equimolar concentrations was 217% (95% confidence interval 116-409%). Both substances elicited reactions at very low levels of exposure. It is concluded that the differences in elicitation capacity between the 2 substances are counterbalanced by exposure being greater to atranol than to chloroatranol and that both substances contribute to the clinical problems seen in oak moss absolute-sensitized individuals.

Allergic Contact Dermatitis to Cosmetics

Cosmetics are used to enhance one's appearance and are used by women worldwide. This article reviews the epidemiology, clinical features, and management of cosmetic allergic contact dermatitis. Additionally, several important cosmetic-related allergens are discussed.