Fragrance Allergy

Fragrance allergy is one form of allergic contact dermatitis caused by a fragrance chemical.

Fragrances and perfumes can either be synthesized or derived from a natural extract. They produce a pleasant scent or help to diminish the unpleasant scent of a product.

For an allergy to develop, previous sensitization to the fragrance chemical is required. Repeated skin contact with the chemical results in a delayed hypersensitivity reaction (type IV) that can arise within hours to days after exposure.

Fragrance allergy is common and affects about 1% of adults. The rates in children and adolescents are slightly higher, accounting for 1.8%.

Fragrances are not limited to perfumes and cosmetic products. They are also found in the following products:

• Personal care products such as shampoos, conditioners, body washes, and baby wipes.
• Flavours added into lipsticks, toothpastes, food, and drinks.
• Topical medicaments and balms.
• Electronic cigarettes.
• Household products such as fabric softener, cleaning agents, and candles.

Any individual who uses fragranced products or experiences frequent exposures can eventually become sensitized to them.

According to the Consumer Safety review of fragrances conducted by the European Scientific Committee in 2011, 82 substances were identified as contact allergens. Fifty-four of those were classified as synthetic chemicals and 28 were classified as natural extracts. Twelve of the chemicals and 8 of the natural extracts were identified as being at high risk of resulting in sensitization.

Fragrance allergy presents as dermatitis, usually as scaly erythematous plaques. Swelling, bullae, and vesicles may be observed. The affected areas may itch, burn, or sting.

Prolonged exposure to the allergen may lead to chronic dermatitis with excoriation and lichenification.

Streaky patterns are observed in areas that came into direct contact with the fragrance allergen. In women, the face, neck, and hands are commonly affected sites. In men, the most affected sites include the hands, face, and lower legs. Armpits can be affected in both sexes. The fragrance chemical can also be transferred to an unexpected site; for instance, from the hands to the face.

The diagnosis of fragrance allergy is usually confirmed by patch testing. Approximately 10% of patients who undergo patch testing are found to have a fragrance allergy.

The first step in treating fragrance allergy is to identify the allergen. Where possible, contact with and exposure to the allergen should be avoided or minimized. Allergic contact dermatitis caused by exposure to a fragrance allergen is treated with a topical steroid selected in accordance with the body site and severity, regular use of emollients, or a short tapering course of a systemic steroid such as prednisone.

Fragrances are ubiquitous and complete avoidance can be challenging. It is therefore recommended that fragrance-allergic patients avoid using products without labels or products that contain any fragrance. Products labelled as "fragrance-free" may still include masking fragrances.