How are people allergic to fragrances

Fragrance allergy, allergy to perfume and fragrances

What is a fragrance allergy? How does the allergy to perfume and fragrances arise? What prevention and treatment does our dermatologist practice in Munich offer?
by Dr. med. Harald Bresser, dermatologist, Munich 

"What are fragrances?" 

Fragrances are natural, natural or artificial substances that smell good. They are obtained primarily from plants, but increasingly also made purely synthetically. Natural fragrances are balms and extracts from plants, or so-called essential or volatile oils of vegetable, animal or fossil origin. Fragrances are added to numerous everyday objects, personal care products, medicines, etc. They have different functions: 1) the product itself should smell "good". Example: fresh laundry should smell "fresh" by adding scents, strawberry yoghurt should smell like strawberries, even if it contains hardly any strawberries 2) artificial scents should cover up unpleasant smells. Example: Toilet cleaning agent should cover toilet odors with a lemon odor; With special sprays, car dealers give the car interior a pleasant fresh leather scent instead of a plastic odor. 3) Fragrances should give people a pleasant body odor and mask the natural body odor. Example: Chanel No. 5 on the skin, apple scent in the shampoo.

"What is a fragrance allergy?" 

Fragrance allergies are part of the so-called type 4 allergies and are therefore contact allergies. They develop after repeated direct skin contact, sometimes also through air contact. Personal care products that have been used more often or for a long time and that have always been well tolerated can lead to allergies. The allergy hazard of the fragrances is very different. The allergy risk is lower with natural plant distillates, e.g. rose water, than with synthetic mixtures of numerous scent chemicals. The risk can be divided into different categories - which, however, are more of scientific interest, since the allergy sufferer is always the "own" fragrance allergy which is the most risky. Category A: Very high allergy risk

  • Oak moss (Evernia Prunastri) and tree moss (Evernia Furfuracea): often in cosmetic products with a masculine scent, for example in aftershave lotions or deodorants
  • Isoeugenol: a natural component found in plants and their essential oils, especially in clove oil.
  • Cinnamal (cinnamaldehyde): contained in a variety of essential vegetable oils, such as cinnamon leaf oil, hyacinth, grape or lavender oil. The plastics industry uses Cinnamal to mask the plastic smells. Even low concentrations of 0.01 to 0.03 percent cinnamaldehyde in deodorants can trigger eczema in the armpit within a few weeks. Category B: High allergy risk
  • Cinnamyl Alcohol: contained in hyacinth flower, daffodil and cinnamon leaf oil as well as in balsam of Peru.
  • Hydroxycitronellal: artificial lily of the valley fragrance, often used in cosmetics. Deodorants with a concentration of 0.03 to 0.3 percent hydroxycitronellal can lead to allergies on healthy skin in just a few weeks.
  • HMPCC (Lyral): Perfume and cosmetics industry, artificial lily of the valley note rounds off perfume compositions such as lilac and hyacinth. Category C: Low allergy risk
  • Amyl Cinnamal: mainly used for soaps, household products and cleaning products and has an oily, jasmine-like odor. - Citral: fragrance and flavoring substance in cosmetics or liqueur drinks - Eugenol: component of clove and cinnamon oil; contained in toothache medicines, toothpastes, mouthwashes, perfumes and soaps.
  • Farnesol: in deodorants, foot sprays, deodorant washing emulsions and acne care products.
  • Lilial (butylphenyl methylpropional): used in detergents and cosmetic products.
  • Methyl heptine carbonate: in detergents and cold balms. Category D: Very low allergy risk
  • Anise Alcohol, Linalool, Benzyl benzoate, Citronellol, Hexyl Cinnamal, Limonene, Alpha-Isomethylionone, Benzyl Alcohol, Amylcinnamal Alcohol, Benzyl Salicylate, Coumarin, Geraniol, Benzylcinnamate.

"How common are fragrance allergies?"

Fragrance allergies are among the most common contact allergies. Women are affected more often than men. The most common contact allergy in men, the second most common in women after nickel allergy.

"Where do fragrances occur?" 

We encounter fragrances all the time in everyday life. From toothpaste, shower products to shampoo, laundry detergent to deodorant, aftershave, perfume to scented candles, we can hardly avoid fragrances in everyday life. Cars are artificially scented with leather and fresh scent in the dealership, bakeries blow the artificial smell of coffee into the pedestrian zones, and hardly any department store can do without fragrance columns in the sales rooms. Fortunately, fragrance-free personal care products are increasingly being made as the number of fragrance allergy sufferers continues to grow. Typical everyday products containing fragrances are:

  • Cosmetics, body creams, perfumes, eau de toilette, aftershave, roll-on deodorants, aftershave lotions, lipsticks, shampoo, soap
  • Toothpaste, mouthwash
  • medicinal ointments, suppositories
  • Detergents, detergents, fabric softeners
  • Food such as chewing gum, ice cream, lemonade, pudding, chocolate
  • technical fluids
  • Scented oils, scented candles, room fragrance nebulizers

The fragrance industry uses around 3000 different fragrances, a single eau de toilette can contain 300 or more different fragrances. In cosmetics, the fragrance content is usually 0.2-1% (creams, shampoos ...), and up to 3% in deodorant sticks. Perfumes often contain up to 100 fragrances in concentrations of approx. 0.002-0.03% each. Low concentrations often do not cause any symptoms even for those who are allergic to fragrance. Even quick washing off (e.g. of scented shampoo) can shorten the contact time so that there are no allergy problems. Work-related fragrance allergies are rather rare, but have been described for many professions. Most allergies are acquired privately. Hairdressers, nurses and carers often suffer from fragrance allergies. Bakers and pastry chefs can develop allergies to eugenol, isoeugenol, cinnamaldehyde, vanillin and geraniol; Workers in the cosmetics industry are at risk from all fragrances in production. Dentists are at increased risk compared to eugenol because it is used in dental bases, fillers, mouthwashes and antiseptics. Contact eczema against oak moss constituents has been described in hunters, road construction and railroad workers, farmers and botanists. "How is the fragrance allergy manifested?" Fragrance allergies can take many forms. Itchy redness and dry eczema are typical symptoms; more under keyword "contact eczema". Eyelid eczema or facial discomfort are common. Many people cannot stand even the smallest amount of fragrance; they already react to perfume smells in the elevator or to burning scented candles with nausea or itching. By the way: You can find the story of King Louis XIV's fragrance allergy under "Jokes? True miracles".

"How is the allergy to fragrances examined?" 

A first indication is usually a subjective intolerance to perfumes or creams containing fragrances. In such a case, you should consult a dermatologist who specializes in allergology. Contact allergies are not examined by ENT doctors or pulmonologists with the additional title of allergology, but only by dermatologists. You can recognize the specialists by the additional designation "Allergology". There is not yet a "specialist" for allergology in Germany, but the additional title to specialist suggests many years of continuing education on this subject. This carries out a so-called patch test / patch test. In the first step, fragrance mixtures that are made available by the industry are examined. The test substances are, for example, a mixture of cinnamon alcohols, eugenol, isoeugenol, citronellal, geraniol and oak moss. These mixtures can be broken down further into their individual components. Patch testing with the fragrance mix uncovered 70-80% of all sensitizations. However, in about 60% of the cases with a positive reaction in the fragrance mix, no reaction of the individual substances can be found in the breakdown. The allergy search is made more difficult not only by the large number of fragrances, but also by frequent irritation reactions during the test - so-called false-positive or false-negative reactions. A self-test with pure fragrances is dangerous, as you can provoke the development of an allergy yourself by testing with incorrect, overdosed or impure fragrances. It is sometimes helpful to test your personal hygiene products with the allergy test. However, this does not replace the test against the pure individual substances,

"How is the allergy to fragrances treated?" 

The skin symptoms of the odor allergy are externally treated by the dermatologist with anti-inflammatory creams, often on a steroid basis. After the allergy test, the allergy sufferer receives an allergy pass from the doctor in which the name and occurrence of the allergen are noted. With its help, he can avoid products that contain the incompatible substances when shopping. In contrast to allergies to pollen, in our experience naturopathic therapy is less effective for fragrance allergies; here usually only the consistent avoidance of the triggering fragrances helps.

"Which cross allergies to fragrances should be considered?" 

Fragrance allergy sufferers often do not tolerate other chemically similar substances - even if it is not a cross-allergy in the strict scientific sense. Particular attention is required with Peru balsam, eugenol and isoeugenol (contained e.g. in cloves, cinnamon (cinnamon), allspice / clove pepper (pimento), nutmeg (nutmeg), camphor (camphor), rose oil, carnations, hyacinths, Violets, rosin, cinnamic acid, cinnamic alcohol, fruit acids, tiger balsam, vanilla, tolu balsam, conifer oil, fir oil (coniferyl alcohol), propolis.

"What can I do to avoid fragrances? " 

To avoid fragrances, I have to recognize them. Since 1999, fragrances have to be declared across Europe, ie they have to be listed precisely on the packaging. Unfortunately, the declaration often leaves something to be desired for products from outside Europe. Fragrances are declared and marketed under different names. They are declared, for example, as "fragrances", "perfume", "fragrance" or with the name of the individual substances. According to the Cosmetics Ordinance, fragrances that trigger allergies particularly often have to be specified as individual substances. If a cosmetic also contains other fragrances, this is indicated in the list of ingredients by the INCI collective name "Parfum". The Cosmetics Ordinance also regulates which substances may be used for cosmetics, the maximum amount of the respective substances, the areas of application and the designation of the substances. The ingredients of a cosmetic product are listed on the packaging in the order of the concentration contained in the product. The substance with the highest proportion is mentioned first, the one with the lowest proportion last, fragrances usually come at the end because of their low concentration. The labeling follows the so-called INCI declaration. INCI is the abbreviation for: International Nomenclature Cosmetic Ingredients. These names often differ from the usual chemical names. The pharmacist should be able to help identify the fragrance and find an alternative. Always carry your allergy pass with you so that you can also check your purchase in the drugstore. If you are not sure about the tolerance, you can carry out a rub test in the crook of the elbow with the personal care product. It is first applied to this sensitive area of ​​the skin; if there is no reddening within 48 hours, the product should be tolerated. A good alternative to roll-on deodorants are alum sticks. And against unpleasant smells in the toilet, it helps to burn a match after use - the burning smell covers every odor in a harmless way. Do not use toilet stones, scented trees, room sprays or scented candles. And your perfume - if it is unavoidable - you should not spray directly on your skin, but on your clothing. Look for a "fragrance-free" skin care range in a drugstore or pharmacy and stick with the products that you can tolerate. In hotel rooms or when visiting friends, you should of course refrain from trying out third-party personal care products.

Suspected perfume allergy? We are happy to test you; please make an appointment on Tel 089-677977

Your dermaPraxis Dr. Harald Bresser Peschelanger 11, 81735 Munich, Tel. 089-677977,

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