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Sukakul T, Bruze M, Svedman C. Fragrance Contact Allergy - A Review Focusing on Patch Testing. Acta Derm Venereol 2024; 104:adv40332. [PMID: 39140486 PMCID: PMC11334351 DOI: 10.2340/actadv.v104.40332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 06/27/2024] [Indexed: 08/15/2024] Open
Abstract
Fragrance materials are widely used in various types of products in daily life and many of them can be contact sensitizers. Contact allergy to fragrances has been reported to be common worldwide. Unlike other groups of contact allergens such as metals and preservatives, fragrance materials in consumer products can be present as single fragrance chemicals or in the form of mixtures known as natural complex substances. Due to the complexity of the fragrance materials and the high number of fragrance substances known to cause contact sensitization, selecting suitable materials for patch testing is challenging. Emerging fragrance markers have been additionally introduced in different baseline series for screening to enhance the rate of fragrance contact allergy detection. Moreover, there have been continual updates on basic knowledge, clinical perspectives, sources of exposure, and regulations on the use of fragrance materials. Avoiding pitfalls while performing patch testing with fragrance test materials is also crucial and should not be overlooked. Therefore, this review aims to update knowledge to provide a high-quality holistic approach to fragrance contact allergy diagnosis and management.
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Affiliation(s)
- Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden.
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Sukakul T, Uter W, Gonçalo M, Huggard J, Ljubojević Hadžavdić S, Schuttelaar MLA, Svedman C, Vey M, Isaksson M, Niklasson B, Rustemeyer T, Bruze M. Results of patch testing with five fragrance materials hitherto not tested: A dose-finding study in the clinical population. Contact Dermatitis 2024; 90:566-573. [PMID: 38387040 DOI: 10.1111/cod.14525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/18/2024] [Accepted: 02/08/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND Quantitative risk assessment (QRA) for skin sensitization is used to derive safe use levels of sensitising fragrance ingredients in products. Post-marketing surveillance of the prevalence of contact allergy to these ingredients provides relevant data to help evaluate the performance of these measures. OBJECTIVES To determine a suitable patch test concentration for five fragrance materials that had hitherto not been tested on a regular basis. These concentrations are then to be used in a surveillance study with patch testing consecutive patients over an extended monitoring period. MATERIALS AND METHODS Furaneol, CAS.3658-77-3; trans-2-hexenal, CAS.6728-26-3; 4,8-dimethyl-4,9-decadienal, CAS.71077-31-1; longifolene, CAS.475-20-7; benzaldehyde, CAS.10052-7, were patch tested with other fragrance allergens in four clinics. Patch testing was conducted in three rounds, starting with the lowest concentrations of the five ingredients. The doses were increased in the subsequent rounds if no late-appearing positive reactions and virtually no irritant reactions were reported. RESULTS Overall, 373 patients were tested. No positive allergic reaction was reported to the five ingredients. Patch test results of other fragrance allergens are reported. CONCLUSIONS The highest test concentrations are each considered safe for patch testing consecutive patients. Further surveillance based on these preparations will evaluate the hypothesis that QRA-driven consumer product levels of these fragrances can prevent sensitization.
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Affiliation(s)
- Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
| | - Margarida Gonçalo
- Department of Dermatology, Coimbra University Hospital and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Joseph Huggard
- The Huggard Consulting Group, S.A.R.L., Itzig, Luxembourg
- IFRA VP Scientific Affairs and IDEA Management Team, Brussels, Belgium
| | - Suzana Ljubojević Hadžavdić
- Department of Dermatology and Venereology, School of Medicine University of Zagreb, University Hospital Center Zagreb, Zagreb, Croatia
| | - Marie L A Schuttelaar
- Department of Dermatology, University Medical Center Groningen, Groningen, The Netherlands
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
| | - Matthias Vey
- The Huggard Consulting Group, S.A.R.L., Itzig, Luxembourg
- IFRA VP Scientific Affairs and IDEA Management Team, Brussels, Belgium
| | - Marléne Isaksson
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
| | | | - Thomas Rustemeyer
- Department of Dermatology-Allergology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Faculty of Medicine, Lund University, Malmö, Sweden
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Geier J, Schubert S, Rieker-Schwienbacher J, Brans R, Weisshaar E, Kränke B, Brockow K, Ruёff F, Recke A, Uter W. Declining frequency of sensitization to fragrance mixes I and II: IVDK-data of the years 2012-2021. Contact Dermatitis 2024; 90:470-478. [PMID: 38146081 DOI: 10.1111/cod.14493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 12/08/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023]
Abstract
BACKGROUND EU Commission Regulation 2017/1410 prohibits using atranol and chloroatranol, the main allergens in Evernia prunastri (oakmoss), and hydroxyisohexyl 3-cyclohexene carboxaldehyde (HICC) in cosmetic products. Oakmoss absolute is contained in fragrance mix (FM) I and HICC in FM II which are patch tested as screening mixtures in the baseline series. OBJECTIVE To describe the time trends of reaction frequencies to both FMs as well as to their components in FM-positive patients. METHODS Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK), 2012-2021. RESULTS Positive reactions to FM I (FM II) declined from 9.1% (4.7%) in 2012 to 4.6% (3.0%) in 2021. Full breakdown tests were performed in 24% (FM I) and 31% (FM II), respectively, of the mix-positive patients. From this data, frequencies of sensitization to the 14 single fragrances of FM I and FM II were calculated. For the majority, a decline was noted from 2012/2013 to 2020/2021, for oakmoss absolute 1.9%-0.8% and for HICC 1.8%-0.9%. CONCLUSION EU Commission Regulation 2017/1410 was an effective measure. However, our data have some limitations, possibly causing underestimation of sensitization frequencies to fragrances.
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Affiliation(s)
- Johannes Geier
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | - Steffen Schubert
- Information Network of Departments of Dermatology (IVDK), Institute at the University Medical Center Göttingen, Göttingen, Germany
| | | | - Richard Brans
- Institute for Interdisciplinary Dermatologic Prevention and Rehabilitation (iDerm) at the Osnabrück University, Osnabrück, Germany
- Department of Dermatology, Environmental Medicine and Health Theory, Osnabrück University, Osnabrück, Germany
| | - Elke Weisshaar
- Unit for Occupational Dermatology, Department of Dermatology, Ruprecht-Karls University Heidelberg, Heidelberg, Germany
| | - Birger Kränke
- Department of Dermatology and Venereology, Medical University of Graz, Graz, Austria
| | - Knut Brockow
- Department of Dermatology and Allergology, Technical University Munich, Munich, Germany
| | - Franziska Ruёff
- Department of Dermatology and Allergy, LMU University Hospital, LMU Munich, Munich, Germany
| | - Andreas Recke
- Department of Dermatology, Allergology and Venereology, University of Luebeck, Luebeck, Germany
| | - Wolfgang Uter
- Department of Medical Informatics, Biometry and Epidemiology, University of Erlangen/Nürnberg, Erlangen, Germany
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Sukakul T, Bruze M, Mowitz M, Bergendorff O, Björk J, Dahlin J, Svedman C. Patterns of simultaneous contact allergies in patients with contact sensitization to oxidised linalool and oxidised limonene. Contact Dermatitis 2024; 90:134-142. [PMID: 37852634 DOI: 10.1111/cod.14445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 10/03/2023] [Accepted: 10/08/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Contact allergy rates of linalool and limonene hydroperoxides (HPs) have increased. OBJECTIVES To demonstrate the patterns of simultaneous positive patch test (PT) reactions and prevalences of multiple contact allergies (MCAs) in patients with contact allergy to linalool and/or limonene HPs. METHODS A retrospective analysis of consecutive dermatitis patients in 2015-2020 was performed. RESULTS Of all 4192 patients, 1851 had at least one positive PT reaction. Of these, 410 (22.2%) had MCAs, significantly related to a higher age (p-value = 0.003). Patients with an exclusively positive reaction to linalool HPs but not limonene HPs were shown to have MCAs (p-value <0.001, odds ratio (95% confidence interval) = 4.15 (3.01-5.73)). Patients with simultaneous contact allergies to both linalool and limonene HPs had contact allergies to many other screening and fragrance allergens. CONCLUSIONS Simultaneous positive PT reactions to allergens in baseline series and fragrances are common in patients with the HPs contact allergy, especially linalool HPs. The pattern of simultaneous PT reactions principally suggested the co-sensitization of the cosmetic allergens.
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Affiliation(s)
- Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Ola Bergendorff
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Jakob Dahlin
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Lund University, Skåne University Hospital, Malmö, Sweden
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Sukakul T, Bruze M, Mowitz M, Svedman C. Use of sorbitan sesquioleate in patch test preparations and patch testing with the substance-What do our results mean? Contact Dermatitis 2023; 88:134-138. [PMID: 36305668 PMCID: PMC10092872 DOI: 10.1111/cod.14239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/12/2022] [Accepted: 10/23/2022] [Indexed: 01/14/2023]
Abstract
BACKGROUND Sorbitan sesquioleate (SSO) is a sorbitan fatty acid ester, an emulsifier used in topical products and certain patch test preparations. SSO may affect the patch test results. It has been debated whether to include the substance in the baseline series to avoid misinterpretation of the results. OBJECTIVES To report the prevalence and simultaneous reactions of SSO with other patch test preparations containing SSO as an emulsifier. MATERIALS AND METHODS A retrospective analysis of 3539 dermatitis patients who underwent patch testing from 2016 to 2020 was performed. RESULTS The 5-year SSO contact allergy prevalence was 0.48%, and 1.3% had a doubtful reaction. Patients with a stronger positive reaction (2+, 3+) were more likely to react simultaneously to other allergen preparations containing SSO (p value = 0.018). One patient with a strong reaction to SSO reacted positively to all SSO-containing patch test preparations. Definite fragrance allergens could not be identified in the patients who had simultaneous reactions to SSO and fragrance mix (FM) I. CONCLUSIONS Patch testing with allergen preparations containing SSO affected the patch test interpretation. Fragrance contact allergy could not be ruled out when a patient simultaneously reacted to SSO and FM I. Changing emulsifiers in patch test preparations would be advantageous.
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Affiliation(s)
- Thanisorn Sukakul
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Magnus Bruze
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Martin Mowitz
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - Cecilia Svedman
- Department of Occupational and Environmental Dermatology, Skåne University Hospital, Lund University, Malmö, Sweden
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