PRODUCT ALLERGEN WATCH

Exposing Covert FragranceChemicalsPamela L. Scheinman

Fragrance is the most common cosmetic allergen found when

dermatitis patients are patch tested in the United States and in

many places worldwide. Fragrances are ubiquitous in our daily

lives and are present in items ranging from toiletries to toilet

tissue. Although fragrances enhance the smell or mask un-

pleasant odors of various cosmetics and household items, it

becomes very difficult for fragrance-allergic patients to find

products they can use. Many items labeled unscented and

fragrance-free contain esoteric fragrance chemicals that most

consumers would not recognize. This article details some co-

vert fragrance agents to help physicians better educate their

fragrance-sensitive patients.

Copyright © 2001 by W.B. Saunders Company

OVER THE PAST 2 DECADES, fragrance allergy prev-alence has increased in many places worldwide.1-5 In

dermatitis patients evaluated by patch testing, reactions tothe fragrance mix (FM) have ranged from 6% in Slovenia(1989 to 1998) to a high of 20% in Hong Kong (1987 to1988).1-3,6-11 The average frequency of the above worldwideFM reactions is 11%.12 These studies do differ in geograph-ical areas, time periods and selection criteria for patientsstudied.

Two main screening chemicals are used to test forfragrance allergy, FM and balsam of Peru. FM is composedof 1% each of the following 8 chemicals: cinnamic aldehyde,cinnamic alcohol, eugenol, isoeugenol, hydroxycitronellal,geraniol, oak moss absolute, and �-amyl cinnamic alde-hyde.

Fragrance allergy does correlate with exposure to FMconstituents in products.13 One or more constituents of FMare present in nearly all deodorants,14 popular prestigeperfumes,15 and perfumes used in cosmetics.16 Addition-ally, it has been shown that reactions to FM coreact withfragrances not found in this mix.17 Patch testing with FMdetects approximately 70% to 80% of fragrance-allergicpatients.18 It is believed that 50% to 65% of positive reac-tions to FM are clinically relevant.5,19

BP is a complex mixture of natural fragrance resins

composed of at least 250 constituents including co-niferyl benzoate (the main sensitizer of BP), cinnamicalcohol, cinnamic acid, cinnamyl cinnamate, isoeugenol,eugenol, farnesol, and benzyl alcohol.20 Patch testing withBP will detect approximately 50% of those with fragranceallergy.21

When fragrance allergy is suspected, testing with anextended series of fragrance chemicals is recommended,because false negative reactions to FM can occur. Kat-sarma and Gawkrodger22 reported 7% of fragrance allergicpatients who would have been missed by patch testing withFM alone.

Patients who know, based on patch testing results, thatthey are allergic to fragrance often seek fragrance-freecosmetics and household products. Unfortunately, manyproducts marketed as fragrance-free are not necessarilyfree of fragrance ingredients. Table 1 shows a partiallisting of products marketed as fragrance-free but containvarious fragrance chemicals.

Occasionally, patients are savvy enough to know thatsome products marketed as unscented are not necessarilyfree of fragrance and may contain masking fragrance tocover unpleasant odors. However, even the most astutelabel-reader will not recognize some of the more esotericfragrance chemicals present in some fragrance-free prod-ucts. A partial list of such covert fragrance chemicals canbe found in Table 2. A partial listing of truly fragrance-freeproducts is found in Table 3.

The Code of Federal Regulations instructs the Food and

From the Department of Dermatology, New England Medical Center, Boston, MA.Address reprint requests to Pamela L. Scheinman, MD, New England Medical Center,

750 Washington St, Box 114, Boston, MA 02111.Copyright © 2001 by W.B. Saunders Company1046-199X/01/1204-0011$35.00/0doi:10.1053/ajcd.2001.28697

SECTION EDITOR:

CHRISTEN M. MOWAD, M.D.

Geisinger Medical Center,Danville, PA 17821Email: cmowad@psghs.edu

This section of the Journal highlights new allergensas they appear and provide brief updates on knownallergens of concern. Obviously, this section can onlyserve as a guide, as companies routinely change formu-lations and introduce new product lines. Therefore, thisinformation will not remain constant over the lifetimeof a product. There is no real substitute for label read-ing. Moreover, complete ingredient disclosure is notalways present on the package or package insert of over-the-counter products. Thus, patient education on howto read labels and look for causative allergens cannot beoveremphasized.

American Journal of Contact Dermatitis, Vol 12, No 4 (December), 2001: pp 225-228 225

Drug Administration on its responsibilities and authority.This code defines fragrance (Title 21, Volume 7, Section700.3[d]) as any natural or synthetic substance or sub-stances used solely to impart an odor to a cosmetic product.With this definition, various fragrance agents legally can beincluded in fragrance-free products because these ingredi-ents may have other functions (i.e., rose oil is also anemollient and benzyl alcohol is also a preservative).

Until the mid-nineteenth century, natural extracts offlowers, plants, and (to a lesser extent) animal secretions,had been the only source of raw materials for creation offragrances. A natural fragrance may contain several hun-dred different chemicals, a few major ones, and manyminor ones. Therefore, for example, a person who is sen-sitized to geraniol (one of the FM constituents) couldtheoretically have difficulty with botanical products con-taining rose oil, palmerosa oil, or geranium oil, becausethese essential oils all contain geraniol.

Many all-natural and herbal products contain fragranceallergens, sometimes at high enough concentrations toinduce sensitization.23,24 Even weak sensitizers used inareas of high absorption (face, genitalia, axillae), trauma-tized sites (beards, shaved legs, and axillae), or chronicdermatitis can result in sensitization.25,26

Although current fragrance guidelines are aimed atpreventing sensitization by setting limits for concentra-

tions of certain known fragrance sensitizers and completelybanning others,27 these guidelines are not directed at pre-venting elicitation of contact dermatitis in those who arealready allergic. In a previously sensitized patient, a lowerdose per unit area of an allergen can result in elicitation ofdermatitis. Roggeband et al28 discuss the benefit of inves-tigating threshold levels of sensitizers, below which therewill be no elicitation of contact dermatitis reactions inpreviously sensitized individuals. These types of elicitationthreshold studies would be very helpful for patients allergicto various fragrance ingredients.

Some Covert Fragrance Agents

Benzyl alcohol is a colorless liquid with a relatively weak,slightly sweet odor. It occurs in many essential oils

Table 3. Partial Listing of Truly Fragrance-Free Products*

SoapsKiss My Face Pure Olive Oil soapCetaphil Gentle Skin Cleanser†CVS Transparent Facial Bar Soap–UnscentedNeutrogena® Therapeutic Facial Bar–Fragrance-Free

MoisturizersCVS Unscented Dry Skin Care LotionEucerin Original Moisturizing CreamVanicream Cream and LotionCurell Lotion Fragrance-FreeVaseline Petroleum Jelly

ShampoosFree and Clear Shampoo and ConditionerT/SA1 Shampoo

DeodorantsAlmay Clear Gel Fragrance-Free DeodorantBan Unscented Roll-On

SunscreensNeutrogena Sensitive Skin Sunblock SPF 17Vanicream Sunscreen SPF 15

*Formulations frequently change and there are often many differentformulations of the same product, so careful reading of labels is alwaysrequired.†Note: liquid; not the bar soap.

Table 1. Partial Listing of Products Marketed as Fragrance Free but Contain Fragrance Chemicals

Product Fragrance Ingredient(s)

Almay Wake-Up Call! Energizing Makeup Ginger root extract, lavenderAveeno Daily Moisturizing Lotion Benzyl alcoholBasis Sensitive Skin Bar Cyclopentadecanolide, almond oil, chamomile extractCetaphil Moisturizing Lotion Benzyl alcohol, farnesolClinique Deep Comfort Body Moisture Coriander, lavenderClinique Exceptionally Clean Clarifying Shampoo Rosemary, spearmintDove Beauty Bar Sensitive Skin Sweet almond oil, rosewood oil, rose oil, cedarwood oilEstee Lauder Verite Soothing Spray Toner Geranium extract, rose waterEstee Lauder Verite Light Lotion Cleanser LavenderKeri lotion Fast Absorbing Benzyl alcoholMoisturel Therapeutic Lotion Benzyl alcoholVaseline Intensive Care Lotion Ethylene brassylate

Table 2. Partial Listing of Covert Fragrance Agents

Benzyl alcoholBenzaldehydeBisabolol (chamomile oil)Citrus oilsCyclopentadecanolideEssential oils and various flower or plant extractsEthylene brassylateFarnesolLinaloolMentholPeruvian balsamPhenyl ethyl alcoholVanilla, almond oil and other flavorings

Pamela L. Scheinman226

and foods and is one of the constituents of BP. It isused in fragrance compositions mainly as a solventand diluent.29

Benzaldehyde is a colorless liquid with a bitter almondodor. It occurs in many essential oils and is the main,characteristic component of bitter almond oil. It is thestarting material for a large number of fragrance andflavor compounds.29

Ethylene brassylate has a sweetish, slightly fatty, muskyodor. It is an artificial fragrance compound used inlarge amounts in perfumery as a fixative. Its tradename is Musk T (Takasago Perfumery Company,Japan).29

Farnesol is a colorless liquid that is a component ofmany blossom oils. The trans-trans isomer is the mostcommon in nature and occurs in ambrette seed oil. Ithas fixative qualities.29

Menthol is a cyclic terpene alcohol. The (�)-menthol isthe isomer occurring most widely in nature and is themain component of peppermint and cornmint oils. Itexerts a cooling/refreshing effect and therefore isused in cigarettes, cosmetics, toothpastes, chewinggum, candies, and medicines.29

Phenyl ethyl alcohol is a colorless liquid with a mild roseodor. It is the main component of rose oils, obtainedfrom rose blossoms. It also occurs to a lesser extent inneroli oil, ylang-ylang oil, and geranium oil. It is anideal soap perfume because of its stability in alkali.29

15-pentadecanolide has a delicate musk odor. Found insmall quantities in angelica root oil, it is used in largeamounts in fine fragrances as a fixative. Trade nameis Cyclopentadecanolide.29

Linalool is a colorless liquid with a lily of the valley odor.It can be isolated from rosewood oil, shiu oil, andcoriander oil. It has 2 enantiomers, (�)-linalool and(�)- linalool. Linalool is produced in large quantitiesand is one of the most frequently used fragrancesubstances.29

Chamomile oil (bisabolol) is available in 3 types: blue,Roman, and Moroccan. The blue chamomile oil is adeep blue liquid that turns green and then, finally,brown when exposed to light and air. It has a strongcharacteristic scent and bitter taste. Chamazuleneand (�)-�-bisabolol contribute to the anti-inflamma-tory properties of this oil.29

Conclusion

Manufacturers should take into account the actual expo-sure that will result from a fragranced product to helpminimize sensitization, because application to potentiallytraumatized or dermatitic areas increases risk of sensitiza-tion. Additionally, elicitation threshold studies for variousfragrance allergens would be very helpful for sensitized

individuals, because there exists a dose per unit area for allallergens below which allergic contact dermatitis will notbe elicited even in sensitized individuals.

Most importantly, manufacturers must be more forth-right when it comes to marketing fragrance-free products.Fragrance-allergic patients would certainly benefit fromeasy availability of products that are really free of fra-grance chemicals. This way allergic patients will not en-counter their allergens in assumed safe products.

References

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Exposing Covert Fragrance Chemicals 227

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