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

Fragrance allergens in cosmetic products marketed for children in Denmark

BACKGROUND

Fragrances are among the most common contact allergens in children. Cosmetic products are the most frequent source of skin exposure.

OBJECTIVE

To investigate exposure to fragrance allergens among Danish children, based on a sample of 1179 cosmetic products marketed for children.

METHODS

Information regarding cosmetic products marketed to children was obtained using a non-profit smartphone application registry, with data from December 2015 to November 2022.

RESULTS

The number of validated products was 26  537, of which 1349 marketed for children. After elimination of duplicates, 1179 (4.4%) individual products remained. The majority 53.8% (634/1179) of the products were fragranced. The highest frequency of declared fragrances was found in 'Facial care'-products: 93.0% (80/86), of which 97.7% were lip balms. The highest number of labelled fragrances in one single product (n = 16) was found in a baby perfume. Fragrance mix I (FMI) or II (FMII) allergens were found in 25.3% (298/1179) of the products. Limonene and linalool were the two most frequently labelled fragrance allergens.

CONCLUSION

Children can be exposed to a vast number of fragrance allergens from scented cosmetic products. Allergens from FM I and FMII are widely used in cosmetic products marketed to children. Patch testing with FMI and FMII remains relevant in children.

Odour Load of Selected Elements of the Technological Line at a Municipal Waste Biogas Plant

Technological processes associated with municipal solid waste (MSW) processing are a potential source of odorant emissions, i.e., substances that cause negative olfactory impressions. When released into the atmosphere, these substances can cause odour nuisance complaints from residents. Many scientists have noted the strong relationship between odorant emission sources and odour concentrations and their significant impact on the living comfort of residents near these sources, as well as their social and economic relations. This paper attempts to estimate the odour load of selected elements of the technological sequence of a biogas plant processing municipal waste. Odour load was characterised by four constituents: odorant emissions, odour emissions, the variability of these emissions, and the emission levels per 1 Mg (1000 kg) of waste. The highest odour emissions accompany the storage of mixed MSW, which is associated with a large amount of waste. Limiting the storage time of waste should be an indispensable part of the technological regime. The dominant odorant associated with mixed MSW storage is NH3 emissions. The greatest variability of odorant and odour emissions concerns gases captured from selectively collected waste plastics and metals, due to the varied forms of selective waste collection in the service area, and their unstable efficiency. High variability of NH3 and odour emissions also accompanies digestate dewatering.

Quality of life in patients with allergic and immunologic skin diseases: in the eye of the beholder

Allergic and immunologic skin diseases negatively impact the quality of life (QoL) of affected patients with detrimental consequences. Nonetheless, in everyday clinical practice the evaluation of QoL is often overlooked. Considering the increasing prevalence of atopic dermatitis, allergic contact dermatitis, hereditary angioedema, cutaneous mastocytosis, and urticaria, it is essential to determine the effects of allergic and immunologic skin diseases on QoL. A joint meeting (GET TOGETHER 2021) of the Italian Society of Allergology, Asthma and Clinical Immunology (SIAAIC) and the Italian Society of Allergological, Occupational and Environmental Dermatology (SIDAPA) aimed to summarize the features of the main QoL tools used in these diseases and to describe the extent of QoL impairment as well as the impact of treatments on QoL, particularly biologic therapies. The assessment of QoL in patients with allergic and immunologic skin diseases relies on generic, organ-specific and disease-specific questionnaires. While generic and organ-specific questionnaires allow comparison between different diseases, disease-specific questionnaires are designed and validated for specific cohorts: the QoL Index for Atopic Dermatitis (QoLIAD) and the Childhood Atopic Dermatitis Impact Scale (CADIS) in atopic dermatitis, the ACD-11 in allergic contact dermatitis, the Angioedema QoL Questionnaire (AE-QoL) and the Hereditary Angioedema QoL questionnaire (HAE-QoL) in hereditary angioedema, the Mastocytosis QoL Questionnaires (MCQoL e MQLQ) in cutaneous mastocytosis, and the Chronic Urticaria QoL questionnaire (CU-Q2oL) in urticaria. Among the many factors that variably contribute to QoL impairment, pruritus can represent the leading cause of patient discomfort. Biologic therapies significantly ameliorate QoL in atopic dermatitis, hereditary angioedema, mastocytosis and chronic urticaria. In general, adequate management strategies are essential for improving QoL in patients with allergic and immunologic skin diseases.

A review of environmental odor quantification and qualification methods: The question of objectivity in sensory analysis

For several years, various issues have up surged linked to odor nuisances with impacts on health and economic concerns. As awareness grew, recent development in instrumental techniques and sensorial analysis have emerged offering efficient and complementary approaches regarding environmental odor monitoring and control. While chemical analysis faces several obstacles, the sensory approach can help overcome them. Therefore, this latter may be considered as subjective, putting the reliability of the studies at risk. This paper is a review of the most commonly sensory methodology used for quantitative and qualitative environmental assessment of odor intensity (OI), odor concentration (OC), odor nature (ON) and hedonic tone (HT). For each of these odor dimensions, the assessment techniques are presented and compared: panel characteristics are discussed; laboratory and field studies are considered and the objectivity of the results is debated. For odor quantification, the use of a reference scale for OI assessment offers less subjectivity than other techniques but at the expense of ease-of-use. For OC assessment, the use of dynamic olfactometry was shown to be the least biased. For odor qualification, the ON description was less subjective when a reference-based lexicon was used but at the expense of simplicity, cost, and lesser panel-training requirements. Only when assessing HT was subjectivity an accepted feature because it reflects the impacted communities' acceptance of odorous emissions. For all discussed dimensions, field studies were shown to be the least biased due to the absence of air sampling, except for OC, where the dispersion modeling approach also showed great potential. In conclusion, this paper offers the reader a guide for environmental odor sensory analysis with the capacity to choose among different methods depending on the study nature, expectations, and capacities.

Analysis of Prevalence and Risk Factors of Contact Sensitization with respect to the Occupational Profiles in a Greek Patient Cohort: A Retrospective Analysis of a Greek Referral Centre and Future Perspectives

Contact dermatitis is a frequent skin disorder related to environmental and occupational etiological factors, which could potentially affect all age groups, as well as both genders. The current study is aimed at exploring the patterns of contact sensitization with respect to the population's occupational patterns in Greece. A retrospective analysis was performed in a cohort of 1978 patients from 2014 to 2016. Patients were divided into two categories; blue collars (BlC) and white collars (WhC), as well as detailed occupation was considered. Separation was performed on the basis of their profession, i.e., labor workers and handicraftsmen were sorted to the BlC group, while office employees were sorted to the WhC group. The common allergen in all occupational subgroups was nickel sulphate. The three most prevalent allergens in both BlC and WhC were nickel sulphate 5%, fragrance mix (I) 8%, and Balsam of Peru 25%. WhC males were uniquely sensitized to colophony 20% and formaldehyde 2%, and WhC females were uniquely sensitized to 5-chloro-2-methyl-4-isothiazolin-3-one (CMIT) and neomycin sulphate 20%. Sensitization to allergens manifested occupation-specific patterns. Allergic contact dermatitis surveillance is of great importance towards the clinical and systematic understanding of the disease, especially with respect to the patient's occupational profile.

Ubiquity, Hazardous Effects, and Risk Assessment of Fragrances in Consumer Products

Purpose of review

The main aims of fragrances are to create pleasing scents or to mask unpleasant odors. We hereby review their main exposure sources, presumed benefits, and unwanted effects, with special attention to allergic contact dermatitis (prevalence, regulatory environment, risk assessment methodology, and preventive measures).

Recent findings

Fragrances elicit positive emotions and presumably have therapeutic benefits related to stress reduction and memory enhancement. However, they also cause detrimental health or environmental effects including contact dermatitis (irritant and/or allergic), non-eczematous contact reactions, photosensitivity, photo-allergy, and immediate contact reactions, which can negatively impact the quality of life. Fragrances are the most frequent chemicals causing contact dermatitis. Their main sources are cosmetics, household products, industrial substances, food flavorings, oral hygiene products, and topical medications. It is difficult for sensitized patients to avoid contact with fragrances, due to their ubiquity and because manufacturers are not willing to volunteer information regarding fragrance ingredients.

Summary

The treatment of contact dermatitis relies on allergens avoidance which does not “cure” the disease (sensitization persists for life) but prevents disabling illness. The patient should understand that avoiding perfume means to avoid all scented goods and not just perfumes.

Labeling fragrances is key in primary prevention (by giving the healthy individual the chance to make an informed choice to avoid risky substances), diagnosis (by helping the practitioner to plan and interpret patch tests), secondary prevention, and prognosis (by allowing the sensitized patient to follow the avoidance instructions). However, only 26 fragrances are mandatory to be declared in cosmetics. The vague labeling of other fragrance ingredients as “perfume” or “fragrance” hampers the diagnostic and preventive approaches. Therefore, in our opinion, declaration should be mandatory for all fragrance ingredients as well as straightforward so most consumers can understand it. Moreover, legislation should be improved to prevent inappropriately high exposures by forbidding stronger allergens, restricting maximum concentrations in the finished product or fields of application, delivering information regarding the risks to the general public, and controlling the compliance of manufacturers with the regulations. Besides, manufacturers should share information regarding the composition in the final products and provide physicians with samples of all fragrance chemicals whenever needed for patch test investigations.

Impact of Odor Nuisance on Preferred Place of Residence

Context of the research: Research is increasingly carried out to take into account the social behavior of residents, the type of industry located in the area, and perceived preference for the place of residence. The quality of life in urban space is increasingly seen as a problem of cooperation between various stakeholders. These studies not only identify factors and sources of odor emissions, but also serve as the basis for creating systems to alert people living in areas adjacent to industrial areas or harmful and unpleasant industrial emissions. In recent years, environmental issues, particularly unpleasant sensory experiences, have been one of the most important acceptance criteria. Aim of the article: The aim of the study is to assess the impact of odor nuisance in the south-eastern part of Kraków (Płaszów) on the residents’ decision to leave their place of residence. In particular, the research goal was achieved to indicate which of the unpleasant odors may cause a change of residence, as well as to assess the degree of their impact on the decision to move, taking into account the social and demographic characteristics of residents. New in the article: The novelty of the work was the finding out of the residents’ opinions about the quality of life by accepting the place of residence, taking into account the aspect of odor nuisance. Previous studies on odor nuisance have focused on the emission of odors from individual plants. A novelty of this research is its implementation in an urban area, in which numerous industrial plants are located, with various odors emitted. Research methodology: To assess odor nuisance, a measuring tool developed in accordance with VDI 3883 guidelines was used, based on the latest research results on odor and noise nuisance. The questionnaire was developed based on German experience. Conclusions from the research: The data obtained as a result of the research allow us to state that specific smells are so burdensome that they may cause the necessity to leave the place of residence, because the respondents feel various unpleasant smells that have an adverse impact upon the quality of life that they perceive. A possible need for relocation of domiciles out of the current place of residence due to unpleasant smells would affect the perceptible, specific level of grief—the greater it is, the more attached the residents are to their current place of residence.

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.

Fragrance contact allergens in 5588 cosmetic products identified through a novel smartphone application

BACKGROUND

More than 25% of the adult European population suffers from contact allergy, with fragrance substances recognized as one of the main causes. Since 2005, 26 fragrance contact allergens have been mandatory to label in cosmetic products within the EU if present at 10 ppm or above in leave-on and 100 ppm or above in wash-off cosmetics.

OBJECTIVE

To examine exposure, based on ingredient labelling, to the 26 fragrances in a sample of 5588 fragranced cosmetic products.

METHODS

The investigated products were identified through a novel, non-profit smartphone application (app), designed to provide information to consumers about chemical substances in cosmetic products. Products registered through the app between December 2015 and October 2016 were label checked according to International Nomenclature of Cosmetic Ingredients (INCI) for the presence of the 26 fragrance substances or the wording 'fragrance/parfum/aroma'.

RESULTS

The largest product categories investigated were 'cream, lotion and oil' (n = 1192), 'shampoo and conditioner' (n = 968) and 'deodorants' (n = 632). Among cosmetic products labelled to contain at least one of the 26 fragrances, 85.5% and 73.9% contained at least two and at least three of the 26 fragrances, respectively. Linalool (49.5%) and limonene (48.5%) were labelled most often among all investigated products. Hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC/Lyral^® ) was found in 13.5% of deodorants. Six of the 26 fragrance substances were labelled on less than one per cent of all products, including the natural extracts Evernia furfuracea (tree moss) and Evernia prunastri (oak moss). A total of 329 (5.9%) products had one or more of the 26 fragrance substances labelled but did not have 'parfum/fragrance/aroma' listed on the label.

CONCLUSIONS

Consumers are widely exposed to, often multiple, well-established fragrance contact allergens through various cosmetic products intended for daily use. Several fragrance substances that are common causes of contact allergy were rarely labelled in this large sample of cosmetic products.

Perceptions of US and Australian Medical Students and Instructors About Clinical Professional Attire: LAPEL Study

CONTEXT

White coats have long been the professional uniform of physicians. However, when physicians opt to remove the white coat, their clothing underneath is brought to the forefront and can influence how they are perceived by their patients.

OBJECTIVE

To explore the perceptions of medical students and their instructors about appropriate clinical professional attire.

METHODS

An anonymous, voluntary 55-question survey was electronically distributed to medical students and their instructors at 2 US and 2 Australian medical schools. The survey incorporated 30 images of sample attire, 9 demographic questions, and 16 questions regarding culture and context of clothing and accessories.

RESULTS

In total, 411 students and 73 instructors participated in this study. The data revealed that white coats and neckties are nearly absent in Australian clinical attire. Overall, students were significantly more supportive of full facial coverage due to religious or cultural values compared with instructors (P<.001), and US medical students were significantly more supportive than Australian students (P<.001). All cohorts preferred dress code policies that directed students to avoid but not prohibit the use of perfume or cologne. Nose rings were controversial with significantly more support for use from medical students than instructors (pooled cohorts, P=.002). Medical students in both the United States and Australia indicated that they were most influenced by observing the attire of physicians at work (155 [38%]), compared with courses in medical ethics (19 [5%]), school policy (16 [4%]), or hospital policy (9 [2%]).

CONCLUSION

Although regional dress code practices are different in the United States compared with Australia, medical students were overall most influenced by their instructors' attire in clinical settings.

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.