[Contact allergy to fragrances]

Abstract

Background: The incidence of allergy induced by fragrances, leading mostly to the development of contact dermatitis and urticaria chronica, has been growing in a large number of countries. In general, allergy is of non-occupational nature, however, it can also have traits of occupational exposure. The fragrance mix is used in screening for allergy to aromas, but it frequently produces false positive or false negative results of the test. The aim of the study was to assess whether the fragrance mix is suitable for detecting allergy to aromas in persons with suspected occupational allergy and also to analyze types of allergy to separate fragrances.

Material and methods: In a group of 1937 patients diagnosed in the Nofer Institute of Occupational Medicine in Lódź, the incidence of allergy to fragrance mix was assessed. They underwent dermatological examinations and tests with use of the European standard kit (Chemotechnique Diagnostics, Malmö, Sweden) in the years 2000-2005. In addition, in the group of patients with positive tests, the type of allergy to individual aromas was analyzed using fragrance series (Chemotechnique Diagnostics, Malmö, Sweden).

Results: The positive reaction to fragrance mix was found in 99 (5.1%) patients (women--5.2% and men--4.9%). In 57.6% of patients, allergy to balsam of Peru was also observed. Allergy to at least one aroma was diagnosed in 82 (72%) persons tested with an expanded fragrance series. In the remaining 23 (28%) patients, patch tests proved to be false positive. In the latter group, 17 patients showed negative results of the test to balsam of Peru. In the study group, 65% of patients reacted to 1, 2 or 3 and 36% to more aromas. The following allergens sensitized most frequently: cynnamic alcohol, hydroxycitronellal, cinnamic aldehyde, isoeugenol, eugenol, Ylang-Ylang oil, oakmoss absolute, and jasmine. Allergic contact dermatitis was diagnosed in 69.7%, urticaria chronica in 5.1% of patients, atopic dermatitis in 4%, whereas in 21.2% no skin lesions were observed.

Conclusions: The results of the study confirmed observations of other authors that the usefulness of fragrance mix in the diagnosis of allergy to aromas is limited (a high number of false positive results of skin tests). We noticed that a combined reaction to fragrance mix and balsam of Peru is helpful in diagnosis in persons whom a complete allergic diagnosis cannot be performed. We also found less frequent hypersensitivity to oakmoss absolute and more frequent to cinnamic aldehyde and alcohol, hydroxycitronellal, eugenol, isoeugenol in Lódź than in studies reported by other authors.