A negative breakdown test in a fragrance mix I-positive patient does not rule out contact allergy to its fragrance constituents

Declining frequency of sensitization to fragrance mixes I and II: IVDK-data of the years 2012-2021

BACKGROUND

EU Commission Regulation 2017/1410 prohibits using atranol and chloroatranol, the main allergens in Evernia prunastri (oakmoss), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) in cosmetic products. Oakmoss absolute is contained in fragrance mix (FM) I and HICC in FM II which are patch tested as screening mixtures in the baseline series.

OBJECTIVE

To describe the time trends of reaction frequencies to both FMs as well as to their components in FM-positive patients.

METHODS

Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2012-2021.

RESULTS

Positive reactions to FM I (FM II) declined from 9.1% (4.7%) in 2012 to 4.6% (3.0%) in 2021. Full breakdown tests were performed in 24% (FM I) and 31% (FM II), respectively, of the mix-positive patients. From this data, frequencies of sensitization to the 14 single fragrances of FM I and FM II were calculated. For the majority, a decline was noted from 2012/2013 to 2020/2021, for oakmoss absolute 1.9%-0.8% and for HICC 1.8%-0.9%.

CONCLUSION

EU Commission Regulation 2017/1410 was an effective measure. However, our data have some limitations, possibly causing underestimation of sensitization frequencies to fragrances.

The European baseline series and recommended additions: 2023

The European baseline series was last updated in 2019. This article discusses the reasoning behind a further iteration of the series for 2023.

Männer- und Frauenhaut – Genderaspekte

Männer- und Frauenhaut sind unterschiedlich. Männerhaut ist dicker, hat mehr Talgdrüsen und Oberflächenlipide, eine höhere, nicht so divergente Keimzahl wie Frauen, niedrigere transepidermale Wasserverlust (TEWL)-Werte und einen niedrigeren pH-Wert. Die Wundheilung und das Niveau von Antioxidantien ist bei Frauenhaut besser. Männerhaut hat mehr Kollagen, altert an anderer Lokalisation, bei Männern finden sich mehr Falten an der Stirn, bei Frauen mehr Falten perioral. Studien sollten die Auswertung der Daten nach Geschlechtern mit beachten.

Contact sensitization to essential oils: IVDK-data of the years 2010 - 2019

BACKGROUND

Essential oils (EOs) are widely used in cosmetics, perfumes, massage fluids, aroma therapy, and natural medicine. Some essential oils contain contact sensitizers.

OBJECTIVES

To describe the frequency of sensitization to EOs in dermatitis patients presenting in skin clinics including concomitant reactions, to evaluate the EO patch test preparations, and to identify patient groups with an increased risk of EO sensitization.

PATIENTS AND METHODS

Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2010-2019.

RESULTS

Twelve EOs were patch tested in an aimed manner in 10 930 patients, of whom 908 (8.3%) reacted to at least one EO. Only 6 EOs elicited more than 1% positive patch test reactions: ylang ylang (I + II) oil (3.9%), lemongrass oil (2.6%), jasmine absolute (1.8%), sandalwood oil (1.8%), clove oil (1.6%), and neroli oil (1.1%). Concomitant reactions among EOs or to EOs and fragrances were frequent. Among EO-positive patients, women, leg dermatitis patients, patients aged 40 years or more, masseurs and cosmeticians were over-represented.

CONCLUSIONS

Sensitization to EOs occurs, albeit infrequently in most cases. Masseurs and cosmeticians have an increased risk of sensitization to EOs. This article is protected by copyright. All rights reserved.

Simultaneous patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes ‐ an update from southern Sweden

Background

Regularly updating the prevalence of fragrance contact allergy (CA) is important. Patch testing with fragrance markers in the baseline series and the ingredients of fragrance mixes (FMs) is still debated.

Objectives

To update the prevalence and clinical characteristics of patients with fragrance CA. To establish the results of patch testing with individual allergens of FMs.

Methods

A retrospective analysis of 3539 patients with dermatitis who were patch tested with the baseline series and FMs ingredients during 2016 to 2020 was performed.

Results

The prevalence of fragrance CA was 13%. About 10% of these patients with fragrance CA would be missed if the individual ingredients were not tested. Unlike hydroxyisohexyl 3‐cyclohexene carboxaldehyde, there was no decreasing trend of CA to Evernia prunastri (oakmoss) extract after the EU regulation came into force. Patients with CA from only one ingredient of the mixes or having a weak positive reaction to the ingredients were significantly missed when tested with only the fragrance markers in the baseline series.

Conclusions

Patch testing with individual fragrance allergens is crucial for experts to expand knowledge in the fragrance CA field. The concentrations of the allergens in FMs may need to be adjusted to detect patients with fragrance CA, since some were significantly overlooked.

What is the added value of patch testing with 30 fragrance allergens in addition to the European baseline series?

Background

Patch testing with the fragrance allergy markers in the European baseline series (EBS) does not identify all patients with fragrance allergy. Hydroperoxides of linalool and limonene have been shown to be useful allergens in detecting fragrance sensitization.

Objectives

To evaluate the added value of testing with 30 fragrance allergens in addition to the EBS.

Methods

All patients with suspected fragrance allergy who underwent patch testing at the Amsterdam University Medical Centers between November 2019 and January 2021 to the EBS and fragrance series were included.

Results

Of 323 patients tested, 162 (50.2%) were found to be fragrance sensitized. The most sensitizing single allergens were the hydroperoxides of linalool (1.0 and 0.5% pet.) and limonene (0.3 and 0.2% pet.). Testing with the hydroperoxides of linalool and limonene identified 62 fragrance‐sensitized patients (38.3%) who could not be detected by the common fragrance markers. Of all fragrance‐sensitized patients, 21 (13.0%) would have been missed when not testing with the fragrance series.

Conclusions

Patch testing with the fragrance series in addition to the EBS is valuable. To reduce the risk of false‐negative reactions, it is advisable to test the hydroperoxides of linalool and limonene.

Highlights

Of the 323 patients with suspected fragrance allergy, 162 (50.2%) were found to be fragrance sensitized.

Testing with the hydroperoxides of linalool and limonene identified 62 fragrance‐sensitized patients (38.3%) who could not be detected by the European baseline series (EBS) fragrance markers. When not tested with the fragrance series, 21 (13.0%) of the sensitized patients would have been missed.

Routinely performing patch testing with the fragrance series in addition to linalool and limonene hydroperoxide as part of the EBS is recommended.

Low Prevalence of Fragrance Contact Allergy Among Turkish Population: A 24-Year, Cross-Sectional, Tertiary Single-Center, Retrospective Study

BACKGROUND

Limited data exist on fragrance contact allergy among Turkish population.

OBJECTIVE

The aim of this study was to investigate the frequency and characteristics of fragrance contact allergy in Turkey.

METHODS

A retrospective cohort study was conducted on 2566 patients consecutively patch tested with the European baseline series and additionally with a fragrance series (n = 358) at a tertiary referral center between 1996 and 2019.

RESULTS

One hundred sixty-three patients (6.4%) (male/female, 1.5:1) were sensitized with at least 1 fragrance allergen. Fragrance mix (FM) I was most frequently positive (3.9%), followed by Myroxylon pereirae (3.1%), FM II (2%), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (0.5%), the latter exclusively positive in FM II-positive patients. Among 358 patients patch tested with a fragrance series, positive patch test reactions were observed in 38 patients, including 8 who did not react to baseline fragrance markers. Clinically relevant fragrance allergy was established in 128 patients (78.5%) from nonoccupational (72.4%) and occupational (6.1%) sources.

CONCLUSIONS

The low prevalence, the middle-aged male preponderance, and the predominant involvement of hands were unusual findings. Rose/citrus-flavored perfumes and eau de cologne, which are traditionally preferred in our country, were important elicitors of fragrance contact allergy, especially among middle-aged and older men.