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Pastor-Nieto MA, Gatica-Ortega ME. Ubiquity, Hazardous Effects, and Risk Assessment of Fragrances in Consumer Products. CURRENT TREATMENT OPTIONS IN ALLERGY 2021; 8:21-41. [PMID: 33520600 PMCID: PMC7825391 DOI: 10.1007/s40521-020-00275-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 01/13/2023]
Abstract
Purpose of review The main aims of fragrances are to create pleasing scents or to mask unpleasant odors. We hereby review their main exposure sources, presumed benefits, and unwanted effects, with special attention to allergic contact dermatitis (prevalence, regulatory environment, risk assessment methodology, and preventive measures). Recent findings Fragrances elicit positive emotions and presumably have therapeutic benefits related to stress reduction and memory enhancement. However, they also cause detrimental health or environmental effects including contact dermatitis (irritant and/or allergic), non-eczematous contact reactions, photosensitivity, photo-allergy, and immediate contact reactions, which can negatively impact the quality of life. Fragrances are the most frequent chemicals causing contact dermatitis. Their main sources are cosmetics, household products, industrial substances, food flavorings, oral hygiene products, and topical medications. It is difficult for sensitized patients to avoid contact with fragrances, due to their ubiquity and because manufacturers are not willing to volunteer information regarding fragrance ingredients. Summary The treatment of contact dermatitis relies on allergens avoidance which does not “cure” the disease (sensitization persists for life) but prevents disabling illness. The patient should understand that avoiding perfume means to avoid all scented goods and not just perfumes. Labeling fragrances is key in primary prevention (by giving the healthy individual the chance to make an informed choice to avoid risky substances), diagnosis (by helping the practitioner to plan and interpret patch tests), secondary prevention, and prognosis (by allowing the sensitized patient to follow the avoidance instructions). However, only 26 fragrances are mandatory to be declared in cosmetics. The vague labeling of other fragrance ingredients as “perfume” or “fragrance” hampers the diagnostic and preventive approaches. Therefore, in our opinion, declaration should be mandatory for all fragrance ingredients as well as straightforward so most consumers can understand it. Moreover, legislation should be improved to prevent inappropriately high exposures by forbidding stronger allergens, restricting maximum concentrations in the finished product or fields of application, delivering information regarding the risks to the general public, and controlling the compliance of manufacturers with the regulations. Besides, manufacturers should share information regarding the composition in the final products and provide physicians with samples of all fragrance chemicals whenever needed for patch test investigations.
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Affiliation(s)
- María-Antonia Pastor-Nieto
- Dermatology Department, Hospital Universitario de Guadalajara, C/ Donantes de Sangre s.n., 19002 Guadalajara, Spain.,Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
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Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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3
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Wang K, Brinker S. Approachable ways to educate patients about reducing environmental health risks. Explore (NY) 2020; 16:199-200. [PMID: 32273177 DOI: 10.1016/j.explore.2020.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Karen Wang
- Collaborative on Health and the Environment and Because Health.
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Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_23-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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6
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Wolkoff P, Nielsen GD. Effects by inhalation of abundant fragrances in indoor air - An overview. ENVIRONMENT INTERNATIONAL 2017; 101:96-107. [PMID: 28126407 DOI: 10.1016/j.envint.2017.01.013] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 12/30/2016] [Accepted: 01/18/2017] [Indexed: 06/06/2023]
Abstract
Odorous compounds (odors) like fragrances may cause adverse health effects. To assess their importance by inhalation, we have reviewed how the four major abundant and common airborne fragrances (α-pinene (APN), limonene (LIM), linalool (LIL), and eugenol (EUG)) impact the perceived indoor air quality as odor annoyance, sensory irritation and sensitization in the airways. Breathing and cardiovascular effects, and work performance, and the impact in the airways of ozone-initiated gas- and particle phase reactions products have also been assessed. Measured maximum indoor concentrations for APN, LIM and LIL are close to or above their odor thresholds, but far below their thresholds for sensory irritation in the eyes and upper airways; no information could be traced for EUG. Likewise, reported risk values for long-term effects are far above reported indoor concentrations. Human exposure studies with mixtures of APN and LIM and supported by animal inhalation models do not support sensitization of the airways at indoor levels by inhalation that include other selected fragrances. Human exposure studies, in general, indicate that reported lung function effects are likely due to the perception rather than toxic effects of the fragrances. In general, effects on the breathing rate and mood by exposure to the fragrances are inconclusive. The fragrances may increase the high-frequency heart rate variability, but aerosol exposure during cleaning activities may result in a reduction. Distractive effects influencing the work performance by fragrance/odor exposure are consistently reported, but their persistence over time is unknown. Mice inhalation studies indicate that LIM or its reaction mixture may possess anti-inflammatory properties. There is insufficient information that ozone-initiated reactions with APN or LIM at typical indoor levels cause airway effects in humans. Limited experimental information is available on long-term effects of ozone-initiated reaction products of APN and LIM at typical indoor levels.
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Affiliation(s)
- Peder Wolkoff
- National Research Centre for the Working Environment, Copenhagen Ø, Denmark.
| | - Gunnar D Nielsen
- National Research Centre for the Working Environment, Copenhagen Ø, Denmark
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Fragrance sensitisers: Is inhalation an allergy risk? Regul Toxicol Pharmacol 2015; 73:897-902. [DOI: 10.1016/j.yrtph.2015.09.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 09/28/2015] [Indexed: 12/20/2022]
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Thyssen JP, McFadden JP, Kimber I. The multiple factors affecting the association between atopic dermatitis and contact sensitization. Allergy 2014; 69:28-36. [PMID: 24372195 DOI: 10.1111/all.12358] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2013] [Indexed: 02/06/2023]
Abstract
Atopic dermatitis and allergic contact dermatitis are both common skin diseases having an immune pathogenesis. There has been considerable interest about their inter-relationships with regard to altered susceptibility. Recent investigations have shed new light on this important question, and in this article, we explore whether there is evidence that atopic dermatitis affects the risk of contact sensitization and allergic contact dermatitis. The use of topical products to treat xerotic and inflamed skin in atopic dermatitis often results in a higher prevalence of sensitization to, for example, fragrances and other ingredients in emollients. Moreover, the prevalence of metal allergy seems to be increased, probably due to compromised chelation of the metals in the stratum corneum of patients with atopic dermatitis. However, conversely, the T-helper cell 2 bias that characterizes immune responses in atopic dermatitis appears to lower the risk of contact sensitization compared to healthy controls. Based on these observations, we conclude that multiple factors affect the association between atopic dermatitis and contact sensitization, and that these need to be appreciated in the clinical management of atopic dermatitis patients.
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Affiliation(s)
- J. P. Thyssen
- National Allergy Research Centre; Department of Dermato-Allergology; Gentofte University Hospital; Hellerup Denmark
| | - J. P. McFadden
- St John's Institute of Dermatology; King's College; St Thomas' Hospital; London UK
| | - I. Kimber
- Faculty of Life Sciences; University of Manchester; Manchester UK
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Tran MTD, Elberling J, Skovbjerg S, Berg ND, Søsted H, Johansen JD, Lysdal SH. Chemical intolerance among hairdressers in Denmark. PLoS One 2013; 8:e71241. [PMID: 23951117 PMCID: PMC3741293 DOI: 10.1371/journal.pone.0071241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2013] [Accepted: 06/28/2013] [Indexed: 12/04/2022] Open
Abstract
Objectives To investigate the prevalence and the severity of fragrance-related symptoms among hairdressers in Denmark compared with the Danish general population. Further, to characterize former hairdressers who are severely chemically intolerant to fragranced products in relation to sex, age and health- and work-related reasons for leaving the hairdressing profession. Methods The study population consisted of all hairdressers who graduated from the public vocational schools in Denmark during 1985 and 2007 (n = 7840) and a random sample of individuals from the Danish general population (n = 6000). Both populations received a postal questionnaire on symptoms from inhalation of fragranced products and the resultant behavioural consequences. All former hairdressers also answered additional questions on health- and work-related reasons for leaving the profession. Results No differences were found in the prevalence (OR = 1.0, CI = 0.89–1.14) or the severity (OR = 1.1, CI = 0.80–1.51) of symptoms from inhalation of fragranced products in hairdressers compared with the general population. Among hairdressers, however, experience of fragrance-related symptoms (OR = 1.2, CI = 1.01–1.31) and adjustments of social (OR = 1.8, CI = 1.12–2.80) and occupational conditions (OR = 2.8, CI = 1.84–4.25) were reported significantly more often by former hairdressers than current hairdressers. Conclusions The prevalence and the severity of fragrance-related symptoms were similar in hairdressers and the general population. Former hairdressers were more affected by fragranced products than current hairdressers were. Although fragrance-related symptoms did not seem to be more frequent among hairdressers, the hairdressing profession might pose a problem for those who are chemically intolerant.
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Affiliation(s)
- Marie Thi Dao Tran
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Copenhagen University Hospital Gentofte, Gentofte, Denmark.
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Masuck I, Hutzler C, Jann O, Luch A. Inhalation exposure of children to fragrances present in scented toys. INDOOR AIR 2011; 21:501-511. [PMID: 21615504 DOI: 10.1111/j.1600-0668.2011.00727.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED When utilized in the perfuming of children's toys, fragrances capable of inducing contact allergy in human skin may also become bioavailable to children via the inhalation route. The aim of this study was to determine the area-specific emission rates of 24 fragrances from a plasticized PVC reference material that was meant to mimic a real plastic toy. This material was introduced into an emission chamber for 28 days at handling conditions or at worst-case conditions. As a result, fragrances can be separated into three categories according to their emission rates ranging from 0.0041 to 16.2 mg/m² × h, i.e., highly volatile, semivolatile, and low-volatile compounds. Compounds of the first and second categories were monitored with decreasing emission rates. Substances of the third category were detected with increasing emission rates over time. Further, higher temperatures led to higher emission rates. The emission concentration of fragrances from four real scented toys varied between 1.10 and 107 μg/m³ at day 1 in the test chamber. Therefore, short-term inhalation exposure to fragrances originating from toys was in the range of 0.53-2700 ng/kg BW/d for the children of age 1 and older. Long-term exposure to these fragrances was calculated in the range of 2.2-220 ng/kg BW/d. PRACTICAL IMPLICATIONS Besides household products and cosmetics, fragrances can be found in toys for children. Some fragrances are known contact allergens in the skin, but there is a lack of information on their effects in the human respiratory tract. Here, we analyzed and categorized fragrances present in a plasticized PVC reference material according to their emission profiles and volatility. We also demonstrate that volatile fragrances are being emitted from real toys and thus may get inhaled under consumer conditions to different extents.
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Affiliation(s)
- I Masuck
- Department of Product Safety, German Federal Institute for Risk Assessment, Berlin, Germany.
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12
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Thyssen JP, Roeske-Nielsen A, Johansen JD. Contact allergy and human biomonitoring--an overview with a focus on metals. Contact Dermatitis 2011; 65:125-37. [PMID: 21692808 DOI: 10.1111/j.1600-0536.2011.01933.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Humans are widely exposed to chemicals. Today, there is an increased acknowledgement of the importance of measuring human and environmental exposures to man-made or refined chemicals. Different approaches have been applied over time, but during the past 25 years, there has been a general trend towards the use of human biomonitoring. A few studies have used human biomonitoring methodology to track contact allergens together with information on patch test reactivity. Hypothetically, the internal load of reactive chemicals might modify the immune response to haptens and the propensity to sensitize and elicit allergic contact dermatitis or develop tolerance. This review offers a general overview of human biomonitoring, including information about its typical application and methodology. Furthermore, studies that have attempted to perform simultaneous biomonitoring and patch testing are reviewed. It is concluded that all studies conducted until the present have focused on one or two routes of exposure (typically skin and oral exposure, but also skin and airway exposure), whereas no studies have investigated all routes at the same time. Also, there is a need for prospective studies, as all epidemiological studies so far have been cross-sectional.
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Affiliation(s)
- Jacob P Thyssen
- Department of Dermato-Allergology, National Allergy Research Centre, Copenhagen University Hospital Gentofte, University of Copenhagen, DK-2900 Hellerup, Denmark.
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Holst H, Arendt-Nielsen L, Mosbech H, Serup J, Elberling J. Capsaicin-induced neurogenic inflammation in the skin in patients with symptoms induced by odorous chemicals. Skin Res Technol 2011; 17:82-90. [PMID: 20923466 DOI: 10.1111/j.1600-0846.2010.00470.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intradermal injection of capsaicin induces the axonal release of neuropeptides, vasodilatation and flare, e.g. neurogenic inflammation. The spatial profile of neurogenic inflammation in the skin has been studied in various experimental models. Polarization spectroscopy imaging introduced recently may be used for the quantitative assessment of the temporal profile of neurogenic inflammation expressed as erythema intensity. PURPOSE In the present study, we aimed to compare capsaicin-induced erythema intensity with the flare area in patients with symptoms induced by odorous chemicals, thereby comparing the temporal and spatial profiles of neurogenic inflammation. METHODS Sixteen patients fulfilling Cullen's criteria for multiple chemical sensitivity (MCS) and 15 eczema (EC) patients with airway symptoms elicited by odorous chemicals were compared with 29 age-matched, healthy controls. Participants were administered two intradermal injections of capsaicin 3.3 and 33μM. Erythema intensity was measured by polarization spectroscopy imaging and flare response was quantified by visual inspection. RESULTS Erythema intensity and flare area did not differ between patients and controls, and they were not correlated. Erythema intensity and flare area showed a dose-dependent increase (P<0.05). Erythema intensity increased with age at 3.3μM but not at 33μM capsaicin, whereas the flare area increased with age at both concentrations (P<0.05). CONCLUSION Capsaicin-induced erythema intensity and visual flare were normal in patients with MCS and EC patients with airway symptoms from odorous chemicals. Polarized light spectroscopy was a useful method for the measurement of the rapid temporal changes in erythema of experimental reactions.
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Affiliation(s)
- Helle Holst
- Dermatology Department, The Danish Research Centre for Chemical Sensitivities, Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
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Berg ND, Linneberg A, Thyssen JP, Dirksen A, Elberling J. Non-allergic cutaneous reactions in airborne chemical sensitivity--a population based study. Int J Hyg Environ Health 2011; 214:239-45. [PMID: 21324740 DOI: 10.1016/j.ijheh.2011.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/10/2010] [Accepted: 01/15/2011] [Indexed: 12/01/2022]
Abstract
Multiple chemical sensitivity (MCS) is characterised by adverse effects due to exposure to low levels of chemical substances. The aetiology is unknown, but chemical related respiratory symptoms have been found associated with positive patch test. The purpose of this study was to investigate the relationship between cutaneous reactions from patch testing and self-reported severity of chemical sensitivity to common airborne chemicals. A total of 3460 individuals participating in a general health examination, Health 2006, were patch tested with allergens from the European standard series and screened for chemical sensitivity with a standardised questionnaire dividing the participants into four severity groups of chemical sensitivity. Both allergic and non-allergic cutaneous reactions--defined as irritative, follicular, or doubtful allergic reactions--were analysed in relationship with severity of chemical sensitivity. Associations were controlled for the possible confounding effects of sex, age, asthma, eczema, atopic dermatitis, psychological and social factors, and smoking habits. In unadjusted analyses we found associations between allergic and non-allergic cutaneous reactions on patch testing and the two most severe groups of self-reported sensitivity to airborne chemicals. When adjusting for confounding, associations were weakened, and only non-allergic cutaneous reactions were significantly associated with individuals most severely affected by inhalation of airborne chemicals (odds ratio = 2.5, p = 0.006). Our results suggest that individuals with self-reported chemical sensitivity show increased non-allergic cutaneous reactions based on day 2 readings of patch tests.
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Affiliation(s)
- Nikolaj Drimer Berg
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Denmark.
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Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2011. [DOI: 10.1007/978-3-642-03827-3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Schnabel E, Schoefer Y, Chen CM, Schäfer T, Behrendt H, Ring J, Wichmann HE, Heinrich J. Sensitization to contact allergens and bronchial hyper-responsiveness. Contact Dermatitis 2010; 63:157-63. [PMID: 20690939 DOI: 10.1111/j.1600-0536.2010.01772.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Exposure to contact allergens and specific allergic sensitization to them are common, but possible related health effects have been rarely studied. OBJECTIVES We aimed to analyse possible associations between contact sensitization to nickel sulfate and fragrance mix I and lung function parameters or bronchial hyper-responsiveness. METHODS Within a population-based study in Augsburg, 1052 adults performed lung function tests, including forced expiratory volume in 1 second (FEV(1)), forced vital capacity (FVC) and bronchial hyper-responsiveness (BHR). Patch tests were performed, and information was assessed by medical examinations and interviews. Logistic regression models were applied to study associations between contact allergies and lung function parameters. RESULTS Women were sensitized significantly more often than men to nickel [odds ratio (OR) 3.97, 95% confidence interval (CI) 2.50-6.29] and fragrance mix I (OR 2.28, 95% CI 1.50-3.46). Patch test results for nickel and fragrance mix I did not influence mean FEV(1) and FVC % predicted values. However, in women, a higher rate of BHR was associated with positive patch test reactions to fragrance mix I (OR 2.24, 95% CI 1.11-4.52). CONCLUSIONS Contact sensitization to fragrance mix I is associated with a higher rate of BHR in women. Thus, in women with contact allergy to fragrances, airway obstruction should be considered as a possible co-morbidity.
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Affiliation(s)
- Eva Schnabel
- Helmholtz Zentrum München, German Research Centre for Environmental Health, Institute of Epidemiology, Neuherberg, Germany.
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Alexandroff A, Flohr C, Johnston G. Updates from the British Association of Dermatologists 89th Annual Meeting, 7-10 July 2009, Glasgow, U.K. Br J Dermatol 2010; 163:27-37. [DOI: 10.1111/j.1365-2133.2010.09814.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Masuck I, Hutzler C, Luch A. Investigations on the emission of fragrance allergens from scented toys by means of headspace solid-phase microextraction gas chromatography–mass spectrometry. J Chromatogr A 2010; 1217:3136-43. [DOI: 10.1016/j.chroma.2010.02.072] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 02/22/2010] [Accepted: 02/24/2010] [Indexed: 11/25/2022]
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Schnuch A, Oppel E, Oppel T, Römmelt H, Kramer M, Riu E, Darsow U, Przybilla B, Nowak D, Jörres R. Experimental inhalation of fragrance allergens in predisposed subjects: effects on skin and airways. Br J Dermatol 2009; 162:598-606. [DOI: 10.1111/j.1365-2133.2009.09510.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Elberling J, Lerbaek A, Kyvik KO, Hjelmborg J. A twin study of perfume-related respiratory symptoms. Int J Hyg Environ Health 2009; 212:670-8. [PMID: 19502109 DOI: 10.1016/j.ijheh.2009.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/05/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
Respiratory symptoms from environmental perfume exposure are main complaints in patients with multiple chemical sensitivities and often coincide with asthma and or eczema. In this population-based twin study we estimate the heritability of respiratory symptoms related to perfume and if co-occurrences of the symptoms in asthma, atopic dermatitis, hand eczema or contact allergy are influenced by environmental or genetic factors common with these diseases. In total 4,128 twin individuals (82%) responded to a questionnaire. The heritability of respiratory symptoms related to perfume is 0.35, 95%CI 0.14-0.54. Significant associations (p<0.05) between perfume-related respiratory symptoms and asthma, atopic dermatitis, hand eczema or contact allergy are not attributable to shared genetic or shared environmental/familial factors, except possibly for atopic dermatitis where genetic pleiotropy with respiratory symptoms to perfume is suggested by an estimated genetic correlation of 0.39, 95%CI 0.09-0.72.
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Affiliation(s)
- J Elberling
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Ledreborg Alle 40, 2.th, DK-2820 Gentofte, Denmark.
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Skovbjerg S, Johansen JD, Rasmussen A, Thorsen H, Elberling J. General practitioners' experiences with provision of healthcare to patients with self-reported multiple chemical sensitivity. Scand J Prim Health Care 2009; 27:148-52. [PMID: 19452353 PMCID: PMC3413186 DOI: 10.1080/02813430902888355] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE To describe general practitioners' (GPs') evaluation of and management strategies in relation to patients who seek medical advice because of multiple chemical sensitivity (MCS). DESIGN A nationwide cross-sectional postal questionnaire survey. The survey included a sample of 1000 Danish GPs randomly drawn from the membership list of GPs in the Danish Medical Association. SETTING Denmark. RESULTS Completed questionnaires were obtained from 691 GPs (69%). Within the last 12 months 62.4% (n = 431) of the GPs had been consulted by at least one patient with MCS. Of these, 55.2% of the GPs evaluated the patients' complaints as chronic and 46.2% stated that they were rarely able to meet the patients' expectations for healthcare. The majority, 73.5%, had referred patients to other medical specialties. The cause of MCS was perceived as multi-factorial by 64.3% of the GPs, as somatic/biologic by 27.6%, and as psychological by 7.2%. Partial or complete avoidance of chemical exposures was recommended by 86.3%. Clinical guidelines, diagnostic tools, or more insight in the pathophysiology were requested by 84.5% of the GPs. CONCLUSION Despite the lack of formal diagnostic labelling the patient with MCS is well known by GPs. The majority of the GPs believed that MCS primarily has a multi-factorial explanation. However, perceptions of the course of the condition and management strategies differed, and many GPs found it difficult to meet the patients' expectations for healthcare. The majority of the GPs requested more knowledge and clinical guidelines for the management of this group of patients.
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Affiliation(s)
- Sine Skovbjerg
- Department of Dermatology, the Danish Research Centre for Chemical Sensitivities, Gentofte Hospital, University of Copenhagen, Denmark.
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Berg ND, Linneberg A, Dirksen A, Elberling J. Phenotypes of individuals affected by airborne chemicals in the general population. Int Arch Occup Environ Health 2008; 82:509-17. [DOI: 10.1007/s00420-008-0352-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 08/03/2008] [Indexed: 11/24/2022]
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Abstract
Genetic factors presumably play a role in contact allergy (CA). There is, however, a lack of conclusive evidence from clinical studies. This may be on account of the strongly competing or modifying impact of exogenous factors, namely the potency of allergens and the intensity of exposure, and the fact that - in principle - everybody can be sensitized. Regarding phenotype, in contrast, polysensitization (PS) seems to indicate a subset of individuals at greater risk. In human sensitization experiments with dinitrochlorobenzene, induction was facilitated in PS, and elicitation enhanced. Recent clinical epidemiological data, taking confounders for PS, such as age, sex, and other skin diseases into account, demonstrated the following: (i) PS was the greatest risk factor to be sensitized to a number of (even weak) index allergens, indicating higher susceptibility on the level of induction; (ii) patch test reactions in PS patients were generally stronger indicating higher susceptibility on the level of elicitation. These findings are complemented by reports on polymorphisms of TNF-alpha and IL-16 in PS patients. Future studies on the genetics of CA should be performed in subgroups with PS, focussing on polymorphisms relevant for CA-specific and nonspecific (inflammatory) processes.
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Affiliation(s)
- A Schnuch
- Center of the Information Network of Department of Dermatology, Institute at University of Göttingen, Göttingen, Germany
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Abstract
Reports on airborne dermatoses are mainly published in the context of occupational settings. Hence, in recent years, dermatologists and also occupational physicians have become increasingly aware of the airborne source of contact dermatitis, resulting mainly from exposure to irritants or allergens. However, their occurrence is still underestimated, because reports often omit the term 'airborne' in relation to dust or volatile allergens. For the present update, we screened the journals 'Contact Dermatitis' (July 2000 to December 2006); 'Dermatitis', formerly named 'American Journal of Contact Dermatitis'; 'La Lettre du Gerda' (January 2000 to December 2006); and also included relevant articles from other journals published during the same period. This resulted in an updated list of airborne dermatitis causes.
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Affiliation(s)
- Raquel Santos
- Department of Dermatology, Hospital de Curry Cabral, P-1069-166 Lisboa, Portugal
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Elberling J, Skov PS, Mosbech H, Holst H, Dirksen A, Johansen JD. Increased release of histamine in patients with respiratory symptoms related to perfume. Clin Exp Allergy 2007; 37:1676-80. [PMID: 17877753 DOI: 10.1111/j.1365-2222.2007.02824.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Environmental perfume exposure may cause respiratory symptoms. Individuals with asthma and perfume contact allergy report such symptoms more frequently than others. However, immunologic mechanisms have not been demonstrated and the symptoms are not associated with IgE-mediated allergy. The study aimed to investigate whether basophils from patients with respiratory symptoms related to perfume released more histamine in the presence of perfume as compared with healthy volunteers. METHODS Histamine release was measured by the glass fibre method. Blood was obtained from healthy volunteers (n=20) and patients with respiratory symptoms related to perfume (n=17) attending a dermatological outpatient clinic for patch testing. The effect of an international brand perfume was investigated using the basophil histamine release test with perfume. Furthermore, basophils from a healthy non-atopic donor were incubated with participant's sera and histamine release induced by perfume was measured. RESULTS In both groups incremental perfume concentrations showed a positive and significant (P<0.001) dose-response effect on the release of histamine. At the highest perfume concentration, the basophils released significantly (P<0.05) more histamine in patients as compared with healthy volunteers. No difference was found between the groups when sera were incubated with basophils from a healthy non-atopic donor. CONCLUSION Perfume induces a dose-dependent non-IgE-mediated release of histamine from human peripheral blood basophils. Increased basophil reactivity to perfume was found in patients with respiratory symptoms related to perfume.
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Affiliation(s)
- J Elberling
- The Danish Research Centre for Chemical Sensitivities, Gentofte University Hospital, Gentofte, Denmark.
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Dotterud LK, Smith-Sivertsen T. Allergic contact sensitization in the general adult population: a population-based study from Northern Norway. Contact Dermatitis 2007; 56:10-5. [PMID: 17177703 DOI: 10.1111/j.1600-0536.2007.00980.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Few studies have so far addressed the prevalence and risk factors for contact sensitization in the general adult population; however, many such studies have been conducted in hospitals. We present the prevalence of contact sensitization in a general adult population and its relationship to potential risk factors like smoking, ear piercing and atopic diseases. 1236 adults (44.2% men and 55.8% women) were randomly selected from a cross-section of the population in Sør-Varanger municipality, Norway, and patch tested with TRUE Test (Pharmacia, Hillerød, Denmark). Contact sensitivity to at least 1 out of 24 allergens was found in 35.4% of the women and in 14.8% of the men. The most common allergens were nickel (17.6%), cobalt (2.8%), thiomersal (1.9%), fragrance mix (1.8%) and colophony (1.2%). All other allergens were observed in 1.0% or less. In women, ear piercing was an important risk factor for nickel sensitization. No such significant correlation was seen in men [in women relative risk (RR) = 3.30, 95% confidence interval (CI) = 2.01-5.43, and in men RR = 1.82, 95% CI = 0.66-5.00], and contact sensitivity was associated with atopic dermatitis (AD) [adjusted odds ratio (OR) = 1.58, 95% CI = 1.04-2.40] and smoking (adjusted OR = 1.42, 95% CI = 1.01-1.99) in women but not in men. The prevalence of contact sensitivity was common in this general population, especially in women. Smoking and AD might be a risk factor for contact sensitization.
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Affiliation(s)
- Lars Kåre Dotterud
- Department of Dermatology, University Hospital of Northern Norway, Tromsø, 9037, Norway.
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Elberling J, Duus Johansen J, Dirksen A, Mosbech H. Exposure of eyes to perfume: a double-blind, placebo-controlled experiment. INDOOR AIR 2006; 16:276-81. [PMID: 16842608 DOI: 10.1111/j.1600-0668.2006.00424.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Environmental perfume exposure can elicit bothersome respiratory symptoms. Symptoms are induced at exposure levels which most people find tolerable, and the mechanisms are unclear. The aim of the study was to investigate patients with eye and respiratory symptoms related to environmental perfume, by exposing the eyes to perfume in a double-blind, placebo-controlled study.Twenty-one eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case-control study. The participants completed a symptom questionnaire, and underwent a double-blind, placebo-controlled exposure to perfume. Of the 42 individuals tested, 10 had more eye symptoms (irritation, itching, and tears) during perfume exposure than during placebo exposures, and eight of these individuals (P = 0.07, Fisher's exact test) belonged to the patient group. A true positive eye reaction to perfume was significantly associated with identification of perfume as an active exposure (P < 0.05). In this study, vapor of perfume elicited irritation in the eyes independently of olfaction, but the relative importance of ocular chemoperception in relation to elicitation of respiratory symptoms from common environmental exposures to perfume remains unclear. We investigated the hypothesis of an association between respiratory symptoms related to perfume and ocular perfume sensitivity by exposing the eyes to perfume in a double blind, placebo-controlled experiment. Vapors of perfume provoked symptoms in the relevant eye in some patients and healthy control persons, but under our exposure conditions, ocular chemesthesis failed to elicit respiratory symptoms.
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Affiliation(s)
- J Elberling
- The National Allergy Research Centre, Gentofte University Hospital, Gentofte, Denmark.
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Straff W, Schnuch A. Umweltbedingte Kontaktallergien. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2006; 49:796-803. [PMID: 16850158 DOI: 10.1007/s00103-006-0010-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Contact allergies are frequent diseases and often lead to social and economic consequences for the patients. The incidence of the clinically manifest allergic contact eczema is between 1.8 and 7 per 1,000 per year, according to the data of the Information Network of Departments of Dermatology (IVDK; http://www.ivdk.org). Contact allergies are frequently acquired at the workplace, but a sensitisation and subsequent manifest disease (elicitation) occurs even more often in the private sphere and then poses a special problem. Even if occupational exposure to the allergen is prevented, e. g. by giving up the job, a full remission is only achieved in about half of the cases due to the ubiquitous existence of the responsible allergens. Contact with substances that have a high sensitisation potential can be avoided to a great extent. Prevention can be achieved by personal protective measures, a decrease of the applied concentration of the allergen, or even restrictions concerning certain chemicals. The prerequisite for this is continuous monitoring of the frequency of sensitizations towards known allergens, as well as an understanding of the substances in use in the environment, including newly introduced chemicals, and the education of the public.
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Affiliation(s)
- W Straff
- Umweltbundesamt, II 1.1 "Umwelthygiene und Umweltmedizin, gesundheitliche Bewertung", Corrensplatz 1, 14195 Berlin, BRD.
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Elberling J, Dirksen A, Johansen JD, Mosbech H. The capsaicin cough reflex in eczema patients with respiratory symptoms elicited by perfume. Contact Dermatitis 2006; 54:158-64. [PMID: 16524439 DOI: 10.1111/j.0105-1873.2006.00793.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Respiratory symptoms elicited by perfume are common in the population but have unclear pathophysiology. Increased capsaicin cough responsiveness has been associated with the symptoms, but it is unknown whether the site of the symptoms in the airways influences this association. The aim of this study was to investigate the association between the site of airway symptoms elicited by perfume and cough responsiveness to bronchial challenge with capsaicin. 21 eczema patients with respiratory symptoms elicited by perfume were compared with 21 healthy volunteers in a sex- and age-matched case control study. The participants completed a symptom questionnaire and underwent a bronchial challenge with capsaicin. Lower, but not upper, respiratory symptoms elicited by perfume were associated with increased capsaicin cough responsiveness. Having severe symptoms to perfume (n=11) did not relate to the site of the symptoms in the airways and was not associated with increased capsaicin cough responsiveness. In conclusion, respiratory symptoms elicited by perfume may reflect local hyperreactivity related to defensive reflexes in the airways, and measurements of the capsaicin cough reflex are relevant when patients with lower respiratory symptoms related to environmental perfume exposures are investigated.
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Affiliation(s)
- Jesper Elberling
- The National Allergy Research Centre, and Deparment of Respiratory Medicine Y, Gentofte University Hospital, Denmark.
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Wolkoff P, Wilkins CK, Clausen PA, Nielsen GD. Organic compounds in office environments - sensory irritation, odor, measurements and the role of reactive chemistry. INDOOR AIR 2006; 16:7-19. [PMID: 16420493 DOI: 10.1111/j.1600-0668.2005.00393.x] [Citation(s) in RCA: 150] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Abstract Sensory irritation and odor effects of organic compounds in indoor environments are reviewed. It is proposed to subdivide volatile organic compounds (VOCs) into four categories: (i) chemically non-reactive, (ii) chemically 'reactive', (iii) biologically reactive (i.e. form chemical bonds to receptor sites in mucous membranes) and (iv) toxic compounds. Chemically non-reactive VOCs are considered non-irritants at typical indoor air levels. However, compounds with low odor thresholds contribute to the overall perception of the indoor air quality. Reported sensory irritation may be the result of odor annoyance. It appears that odor thresholds for many VOCs probably are considerably lower than previously reported. This explains why many building materials persistently are perceived as odorous, although the concentrations of the detected organic compounds are close to or below their reported odor thresholds. Ozone reacts with certain alkenes to form a gas and aerosol phase of oxidation products, some of which are sensory irritants. However, all of the sensory irritating species have not yet been identified and whether the secondary aerosols (ultrafine and fine particles) contribute to sensory irritation requires investigation. Low relative humidity may exacerbate the sensory irritation impact. Practical Implications Certain odors, in addition to odor annoyance, may result in psychological effects and distraction from work. Some building materials continually cause perceivable odors, because the odor thresholds of the emitted compounds are low. Some oxidation products of alkenes (e.g. terpenes) may contribute to eye and airway symptoms under certain conditions and low relative humidity.
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Affiliation(s)
- P Wolkoff
- National Institute of Occupational Health, Copenhagen Ø, Denmark.
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Abstract
Fragrances are increasingly used in private and public domains. Over recent years the olfactory sense has been paid more and more scientific and economic attention. While on the one hand bad smells are counteracted by fragrances, marketing experts are now trying to introduce this sense into multimedia-based experiences. Technical means are used to address positively and directly the sense of smell. The aim is to make the smell a unique feature for a certain brand or location. When it comes to "style of living" or "special shopping experience" nowadays the olfactory design plays an important role. Although fragrances are applied very frequently, there is still a lack of knowledge about the potential consequences for health and the environment. Certain substances (musk compounds) have been proven persistent and accumulative, and others belong to the most common causes of contact eczema. Some people also report special sensitivities towards certain smells for unknown reasons. Unlike audiovisual attractions it is very difficult for humans to avoid olfactory stimuli. The question arises whether fragrance materials constitute a group of substances that should receive more attention concerning their risk for health and the environment.
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Affiliation(s)
- W Straff
- Umwelthygiene und Umweltmedizin gesundheitliche Bewertung, Umweltbundesamt, Berlin, Germany.
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Abstract
PURPOSE OF REVIEW The aim of this article is to review recent findings in contact allergy, regarding clinical research. RECENT FINDINGS The biocide methyldibromo glutaronitrile was identified to be an important sensitizer. Subsequently, it was banned from leave-on cosmetics in the European Union. Another group of important allergens that have been studied extensively included the fragrances oak moss absolute, isoeugenol, hydroxyisohexyl 3-cyclohexene carboxaldehyde and farnesol. A new fragrance mix II has been developed for standard testing, which includes the two latter compounds. Dose response studies have demonstrated broad individual variation of elicitation thresholds, dependent on the allergen concentration during induction, and other factors. Some unsuspected routes of exposure to allergens include oral, inhalational, connubial or airborne contact. Experimental studies provide a classification of newly introduced chemicals; increasingly, the local lymph node assay is supplementing and potentially replacing the guinea pig maximization test. Recent advances in occupational contact allergy include, for example, some attempts to improve diagnostics for epoxy resin and other plastic, glue, and cutting fluid components. SUMMARY Constant awareness for new allergens, confirmed by critical evaluation, standardization of patch test materials, and the identification of temporal patterns and subgroups at risk will improve both the diagnosis and prevention of allergic contact dermatitis.
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Affiliation(s)
- Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen-Nuremberg, Erlangen, Germany.
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Elberling J, Linneberg A, Mosbech H, Dirksen A, Menné T, Nielsen NH, Madsen F, Frølund L, Johansen JD. Airborne chemicals cause respiratory symptoms in individuals with contact allergy. Contact Dermatitis 2005; 52:65-72. [PMID: 15725282 DOI: 10.1111/j.0105-1873.2005.00533.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Exposure to fragrance chemicals causes various eye and airway symptoms. Individuals with perfume contact allergy report these symptoms more frequently than individuals with nickel allergy or no contact allergies. However, the associations between contact allergy and respiratory symptoms elicited by airborne chemicals other than perfumes are unclear. The study aimed to investigate the association between eye and airway symptoms elicited by airborne chemicals (other than perfumes) and contact allergy in a population-based sample. A questionnaire on respiratory symptoms was posted, in 2002, to 1189 individuals who participated in 1997/1998 in a Danish population-based study of allergic diseases. Questions about eye and airway symptoms elicited by different airborne chemicals and airborne proteins were included in the questionnaire. Data from the questionnaire were compared with data on patch testing and prick testing. Having at least 1 positive patch test (adjusted odds ratio 1.7, 95% CI 1.2-2.5) was associated with the symptoms, and the odds ratio increased with the number of positive patch tests (P-value for test for trend <0.05). Bronchial hyperreactivity, female sex and psychological vulnerability were independently associated with symptoms, but no association was found between prick test reactivity to proteins and the symptoms elicited by airborne chemicals.
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Affiliation(s)
- J Elberling
- The National Allergy Research Centre, Department of Dermatology, Gentofte University Hospital, Gentofte, Denmark.
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