Fragrance contact allergic patients: strategies for use of cosmetic products and perceived impact on life situation

Between attraction and avoidance: from perfume application to fragrance-free policies

BACKGROUND

According to a national representative survey, 19.9% of the German population describe various adverse effects on personal health upon exposure to fragranced consumer products. This study investigates whether these fragrance-sensitive persons have a higher risk awareness compared to the general public, whether they show a different safety behavior concerning fragrances and whether they reduce exposure and hence risk.

RESULTS

The presence of fragrances can have a major impact on the participation in public activities. Half of the fragrance-sensitive persons have ever been prevented from going to some place to avoid exposure to fragrances. More than half of them prefer fragrance-free alternatives (products, laundry, hotels, airplanes, health care facilities, or workplaces), while there are also fragrance-sensitive individuals, who indicate to prefer fragranced products and spaces. Half of fragrance-sensitive persons use perfumes to feel themselves more attractive. Furthermore, there is a large number of persons who prefer fragrance-free alternatives without being fragrance-sensitive. Around half of the general population indicate not to use a fragranced product if they know that it emits hazardous air pollutants. This shows that health effects associated with the presence of fragrances proved to be one out of several factors, but not the only one, which influences attitudes towards fragrances and their usage. The answers given reveal the multitude of aspects influencing risk awareness and safety behavior. According to the survey results, 7.4 workdays were lost due to illness from fragranced product exposure in the workplace per person on average, with estimated personal economic costs of 14.5 * 109 Euro/year in Germany.

CONCLUSIONS

The high prevalence of persons who correlate their health effects with exposure to fragrances shows that existing risk communication instruments are too weak, even for people who are aware of a risk, like fragrance-sensitive persons. The data substantiate how important it is to respect cognitive dissonance, confirmation bias and the inadequacy of the deficit model in risk management. The issue of adverse health effects associated with fragrances has reached a dimension, which requires immediate action: The results of this study are strong supporting arguments in favor of fragrance-free policies.

Health impact assessment of a skin sensitizer: Analysis of potential policy measures aimed at reducing geraniol concentrations in personal care products and household cleaning products

A methodology to assess the health impact of skin sensitizers is introduced, which consists of the comparison of the probabilistic aggregated exposure with a probabilistic (individual) human sensitization or elicitation induction dose. The health impact of potential policy measures aimed at reducing the concentration of a fragrance allergen, geraniol, in consumer products is analysed in a simulated population derived from multiple product use surveys. Our analysis shows that current dermal exposure to geraniol from personal care and household cleaning products lead to new cases of contact allergy and induce clinical symptoms for those already sensitized. We estimate that this exposure results yearly in 34 new cases of geraniol contact allergy per million consumers in Western and Northern Europe, mainly due to exposure to household cleaning products. About twice as many consumers (60 per million) are projected to suffer from clinical symptoms due to re-exposure to geraniol. Policy measures restricting geraniol concentrations to <0.01% will noticeably reduce new cases of sensitization and decrease the number of people with clinical symptoms as well as the frequency of occurrence of these clinical symptoms. The estimated numbers should be interpreted with caution and provide only a rough indication of the health impact.

Interested consumers' awareness of harmful chemicals in everyday products

BACKGROUND

Everyday products can contain a multitude of harmful substances unnoticed by most consumers, because established risk communication channels reach only part of the society. The question is, whether at least interested and informed consumers are able to use risk communication tools and assess harmful chemicals in products.

RESULTS

An online survey investigated the awareness of 1030 consumers on harmful substances in everyday items. Participating consumers' education level, knowledge in chemistry, and motivation were above society's average. Although a large number of responses showed that survey participants were familiar with several aspects of the issue, the results revealed that knowledge in chemistry helped, but was not enough. Many participants assumed that products with an eco-label, natural personal care products, products without hazard pictograms or products produced in the European Union would not contain harmful substances. Most participants indicated to use hazard pictograms, information on the packaging, reports in the media, and environmental and consumer organizations as information sources, while information by authorities and manufacturers were not named frequently and did not receive high confidence. Smartphone applications were not indicated by many participants as information sources. The information sources most trusted were environmental and consumer organizations, hazard pictograms, and lists of ingredients on the containers. The declared confidence in certain risk communication instruments did not always correspond to the use frequencies indicated. Nearly all participants considered legislators as responsible for the reduction of harmful substances in consumer products.

CONCLUSIONS

Misconceptions about harmful substances in products can be dangerous for the personal health and the environment. The survey indicates that motivation, educational level, and chemical expertise do not automatically provide an appropriate understanding of harmful substances in products. If well-informed consumers are not sufficiently capable to use risk information elements as revealed in this study, then this will be even more the case for the general public. Consumer awareness should be stipulated by an improved information strategy about chemical risks in consumer products with an extensive participation of the target groups and by more efforts by authorities and manufactures to build trust and to provide easily understandable information.

Natural personal care products-analysis of ingredient lists and legal situation

BACKGROUND

Many natural substances are classified as dangerous substances according to the European regulation on classification and labelling. Are they used in natural personal care products today? One hundred ingredient lists were analyzed to find this out.

RESULTS

All products with natural substances contained dangerous natural substances or they contained natural substances, for which the information about their classification as dangerous substances is not available. 54 natural substances quoted in the ingredient lists were found to be classified, with 37 substances being classified due to hazardous effects for skin and eyes. However, the most frequently used natural substances are not classified as dangerous. Natural substances are multi-constituent compounds, leading to two main problems in personal care products: the potential interactions of a multitude of substances and the fact that dangerous constituents are not disclosed in the ingredient lists. For example, the fragrance allergens citral, farnesol, limonene, and linalool are frequent components of the natural substances employed. In addition, 82 products listed allergenic fragrance ingredients as single substances in their ingredient lists. Recommendations for sensitive skin in a product's name do not imply that the '26 fragrance allergens' are omitted. Furthermore, 80 products listed 'parfum'/'aroma', and 50 products listed ethanol.

CONCLUSIONS

The data show that the loopholes for natural substances and for personal care products in the present European chemical legislation (e.g. the exception for classification and labelling of cosmetic products and the exception for information transfer in the supply chain) are not in line with an adequate consumer and environmental protection.

Fragrance allergic contact dermatitis

Fragrances are a common cause of allergic contact dermatitis in Europe and in North America. They can affect individuals at any age and elicit a spectrum of reactions from contact urticaria to systemic contact dermatitis. Growing recognition of the widespread use of fragrances in modern society has fueled attempts to prevent sensitization through improved allergen identification, labeling, and consumer education. This review provides an overview and update on fragrance allergy. Part 1 discusses the epidemiology and evaluation of suspected fragrance allergy. Part 2 reviews screening methods, emerging fragrance allergens, and management of patients with fragrance contact allergy. This review concludes by examining recent legislation on fragrances and suggesting potential additions to screening series to help prevent and detect fragrance allergy.

Determinants of exposure to fragranced product chemical mixtures in a sample of twins

Fragranced product chemical mixtures may be relevant for environmental health, but little is known about exposure. We analyzed results from an olfactory challenge with the synthetic musk fragrance 1,3,4,6,7,8-hexahydro-4,6,6,7,8,8-hexamethyl-cyclopento-γ-2-benzopyran (HHCB), and a questionnaire about attitudes toward chemical safety and use of fragranced products, in a sample of 140 white and 17 black twin pairs attending a festival in Ohio. Data for each product were analyzed using robust ordered logistic regressions with random intercepts for “twin pair” and “sharing address with twin”, and fixed effects for sex, age, education, and “ever being bothered by fragrances”. Due to the small number of black participants, models were restricted to white participants except when examining racial differences. Overall patterns of association were summarized across product-types through random-effects meta-analysis. Principal components analysis was used to summarize clustering of product use. The dominant axis of variability in fragranced product use was “more vs. less”, followed by a distinction between household cleaning products and personal care products. Overall, males used fragranced products less frequently than females (adjusted proportionate odds ratio 0.55, 95% confidence interval 0.33, 0.93). This disparity was driven by personal care products (0.42, 95% CI: 0.19, 0.96), rather than household cleaning products (0.79, 95% CI: 0.49, 1.25) and was particularly evident for body lotion (0.12, 95% CI: 0.05, 0.27). Overall usage differed by age (0.64, 95% CI: 0.43, 0.95) but only hand soap and shampoo products differed significantly. “Ever being bothered by fragrance” had no overall association (0.92, 95% CI: 0.65, 1.30) but was associated with laundry detergent use (0.46, 95% CI: 0.23, 0.93). Similarly, black vs. white differences on average were not significant (1.34, 95% CI: 0.55, 3.28) but there were apparent differences in use of shampoo (0.01, 95% CI: 0.00, 0.69), body lotion (4.67, 95% CI: 1.18, 18.47), and perfume (6.22, 95% CI:1.08, 35.89). There was no overall association with thinking about product risks (0.90, 95% CI: 0.79, 1.02), nor with inability to smell HHCB (0.84, 95% CI: 0.63, 1.12). Exposure to fragranced products may differ demographically. The relevance for health disparities should be studied.

Fragrance allergy and quality of life - a case-control study

BACKGROUND

Fragrance ingredients can cause contact allergy, which may affect quality of life (QoL). However, few studies have investigated this topic.

OBJECTIVES

To investigate QoL life among subjects with a fragrance allergy as compared with other eczema patients.

METHODS

A case-control survey was sent to subjects with a positive patch test reaction to a fragrance ingredient/marker (n = 550) and to a control group (n = 1100). It contained questions on eczema and the newly developed fragrance QoL index. Participants had been consecutively patch tested at Gentofte University Hospital (2000-2010). The response rate was 65.7%. Information on patch test data was retrieved from the National Contact Dermatitis Database.

RESULTS

An increase in impairment of QoL was observed in women with fragrance allergy as compared with the control group (p = 0.042), which was not found among men. Several factors played a significant role in impairment of QoL in women: (i) number of fragrance allergies, (ii) severity of the patch test reaction, (iii) age combined with recent diagnosis; and (iv) allergy to specific fragrance ingredients/markers.

CONCLUSION

Fragrance-allergic subjects are just as affected in their QoL as other eczema patients. However, women, and in particular recently diagnosed young women, seem to be more impaired in their QoL than other eczema patients.

Consideration of criteria required for assignment of a (skin) sensitiser a substance of very high concern (SVHC) under the REACH regulation

The identification, characterisation, risk assessment and risk management of materials that cause allergic sensitisation is an important requirement for human health protection. It has been proposed that for some chemical and protein allergens, and in particular for those that cause sensitisation of the respiratory tract (associated with occupational asthma), it may be appropriate to regard them as Substances of Very High Concern (SVHC) under the provisions of REACH (Registration, Evaluation, Authorisation and restriction of CHemicals). We have argued previously that categorisation of sensitising agents as SVHC should be used only in exceptional circumstances. In the present article, the subject of SVHC is addressed from another perspective. Here the information that would be required to provide a compelling case for categorisation of a skin sensitising substance as a SVHC is considered. Three skin sensitising chemicals have been identified to serve as working examples. These are chromate, a potent contact allergen, and the skin sensitisers formaldehyde and isoeugenol. The key criterion influencing the decision regarding a skin sensitiser being categorised as SVHC is the extent to which impacts on the quality of life are reversible. Consequently, SVHC categorisation for skin sensitising chemicals should be used only in exceptional circumstances.

Fragrance allergy and quality of life - development and validation of a disease-specific quality of life instrument

BACKGROUND

Fragrance allergy is a lifelong condition that may give rise to permanent or recurrent contact dermatitis and may affect quality of life (QoL). The effect on QoL has not yet been investigated, and no disease-specific QoL instrument for fragrance allergy exists.

OBJECTIVE

To develop and validate a disease-specific instrument to investigate QoL among fragrance-allergic subjects.

METHOD

A fragrance QoL instrument (FQL index) was developed on the basis of narratives from 68 fragrance-allergic subjects, and consisted of 13 items. It was tested in a postal survey among 1650 participants patch tested at Gentofte University Hospital (2000-2010). The survey included other QoL instruments [Dermatology Life Quality Index (DLQI) and Short Form 36 (SF36) version 2] and questions on eczema severity (response rate of 66%). A retest was conducted after 3-6 months (response rate of 72.5%).

RESULTS

The FQL index showed a significant and strong correlation with the DLQI (rS  = 0.70), and disease severity, but a weak correlation with SF36 [mental component summary score, rS  = - 0.22; physical component summary score, rS  = - 0.31]. Good reliability and responsiveness to changes in disease severity were seen.

CONCLUSION

The FQL index is a good instrument with which to investigate QoL in subjects with fragrance allergy. Good correlations with the DLQI and self-estimated disease severity were seen, and it showed good reliability, reproducibility and ability to distinguish changes in disease severity.

The hazard communication of fragrance allergens must be improved

Contact allergy is a global health problem that could be alleviated considerably if the general public could reduce contact to sensitizers. Efficient hazard communication would be a valuable instrument to achieve this. What do current regulations concerning fragrance sensitizers in cosmetic products in Europe contribute? For example, there are bans and restrictions according to the Cosmetic Regulation, there is the "26 allergens rule" that requires that the names of some allergenic fragrance ingredients are listed on the containers, there is labeling and classification of hazardous products according to Regulation 1272/2008, and there is the regulation concerning the registration, evaluation, authorization and restriction of chemicals (REACH). Do these regulations increase consumer protection by suitable hazard communication instruments? Four main problems were identified. First, according to the 26 allergens rule, consumers carry a very large part of the responsibility for risk reduction management. They need to be capable and motivated to recognize the names of strong allergens listed in the ingredient list and decide for themselves whether they want to run the risk or not, provided that they are aware of their responsibility. Second, cosmetic products do not need to be classified and labeled like other consumer goods, according to the European Commission Regulation 1272/2008, if they contain hazardous substances. Third, some pictograms for hazardous substances, for example, the exclamation mark for sensitizers, are not well understood by the majority of the general public. Fourth, very often, the design of cosmetic containers implies health and well being, even if the respective products contain sensitizers or other hazardous substances. Against this background, the following improvements are proposed: 1) the 26 allergens rule needs revision, 2) the exception for cosmetic products from labeling and classification should be abolished, 3) a new self-explanatory pictogram for skin sensitizers and skin irritants should become mandatory for consumer products containing allergens, and 4) packaging of products containing hazardous substances should not be allowed to be attractive and evoke feelings that the products were harmless. Labeling of consumer products can be a very efficient tool for risk communication, however, the addressees must be sufficiently trained to understand the system and know the consequences of their behavior. Transparent labeling will increase the credibility of manufacturers and can lead to a subsequent improved risk management with a benefit for all stakeholders.