Contact allergy to fragrances: current clinical and regulatory trends

The Skin Sensitisation of Cosmetic Ingredients: Review of Actual Regulatory Status

All cosmetics products must be safe under foreseeable conditions of use. Allergenic responses are one of the most frequent adverse reactions noted for cosmetics. Thus, the EU cosmetics legislation requires skin sensitisation assessment for all cosmetics ingredients, including the regulated ones (for which the full toxicological dossier needs to be analysed by the Scientific Committee on Consumer Safety (SCCS)) and those (perceived as less toxic) which are assessed by industrial safety assessors. Regardless of who performs the risk assessment, it should be carried out using scientifically and regulatory body-accepted methods. In the EU, reference methods for chemical toxicity testing are defined in the relevant Annexes (VII-X) of the Registration, Evaluation, Authorisation and Restriction of Chemicals (REACH) Regulation. Recommendations for Skin Sensitization (Skin Sens) testing are provided in Annex VII, and this particular endpoint information is required for all EU-registered chemicals. Historically, in vivo animal and human methods have been used. Both raise ethical doubts, and some of them cause practical problems in the objective analysis of skin sensitising potency. Previous decades of huge effort have resulted in the regulatory acceptance of the alternative Skin Sens IATA (Integrated Approaches to Testing and Assessment) and NGRA (Next Generation Risk Assessment). Regardless of the testing issues, a serious sociological problem are observed within the market: the consumer assumes the presence of strong sensitisers in cosmetics formulations and insufficient risk management tools used by the industry. The present review aims to provide an overview of methods for assessing skin sensitisation. Additionally, it aims to answer the following question: what are the most potent skin sensitisers used in cosmetics? The answer considers the mechanistic background along with the actual regulatory status of ingredients and practical examples of responsible industry solutions in the area of risk management.

Prevalence and Risk Factors of Self-Reported Perfume Sensitivity in Saudi Arabia

Perfumes are widely used products; however, several fragrance substances used in perfuming are well-established allergenic substances and have been attributed to various adverse health reactions. The nature and significance of perfume sensitivity reactions have not been thoroughly investigated. Therefore, this study aimed to identify the prevalence, nature, and associated risk factors of self-reported perfume sensitivity among the general population in Saudi Arabia. A nationally representative cross-sectional study was conducted among adults in Saudi Arabia in October 2020. Significant associated risk factors were explored using multivariate regression analyses. A total of 1078 participants completed the survey, with a mean age of 36.7 years (SD ± 10.36). Perfume sensitivity reactions were reported in 14.6% of participants. From among these participants, 17.8% reported moderate to severe reactions. Respiratory and skin symptoms were the most reported reactions, with total rates of 40.1% and 35.7%, respectively. History of asthma (OR = 3.2, 95%CI 1.88–4.37, p < 0.001) and the use of counterfeit perfume products (OR = 1.9, 95%CI 1.23–2.94, p < 0.003) were significantly associated with a higher risk of perfume sensitivity. Our study revealed that a considerable number of the general population in Saudi Arabia has experienced adverse health reactions due to perfume products. The enormous volume of the perfume market thus necessitates further quantitative analysis studies to determine the presence of allergenic fragrance substances in perfumes.

Multiyear Group and Medical Center Patch Test Frequency Data: Confounding Variables

Patch test frequency data have been extensively published by research groups, such as the International Contact Dermatitis Research Group, North American Contact Dermatitis Group, Dermato-Allergology Study and Research Group, and European Environmental Contact Dermatitis Research Group. As this knowledge accumulation is widely applied in clinical and public health settings, we describe confounding factors to consider when using such data for medical policy considerations. These concepts can also be used in individual reports of new allergens or series of cases. Some of these confounders may have been reported in current literature (until October 2020), whereas others have not been mentioned/considered in most group publications.

Hand dermatitis in adults referred for patch testing: Analysis of North American Contact Dermatitis Group Data, 2000 to 2016

BACKGROUND

Hand eczema (HE) is a heterogeneous and burdensome disorder.

OBJECTIVE

To characterize the clinical characteristics, etiologies and allergen relevance in adults with HE referred for patch testing.

METHODS

Retrospective analysis (2000-2016) of North American Contact Dermatitis Group data (n = 37,113).

RESULTS

Overall, 10,034 patients had HE, with differences of overlap between allergic contact, irritant contact, and atopic dermatitis. Allergic contact HE fluctuated, whereas atopic HE steadily increased, and irritant HE decreased over time. HE was associated with higher proportions of positive patch tests (67.5% vs 63.8%; χ², P < .0001). The five most common clinically relevant allergens were methylisothiazolinone, nickel, formaldehyde, quaternium-15, and fragrance mix I. HE was associated with significantly higher odds of positive patch test reactions and clinical relevance in 13 and 16 of the 25 most common allergens, respectively, including preservatives, metals, topical medications, and rubber accelerators.

LIMITATIONS

No data on HE phenotype.

CONCLUSION

HE in adults was associated with higher proportions of positive patch tests, with a heterogeneous profile of allergens. Patch testing remains an important tool in the evaluation of patients with HE.

Review on perfume and present status of its associated allergens

BACKGROUND

Perfume is basically a cosmetic product applied to human body for an amusing scent or the feeling of freshness. A certain amount of perfume penetrates and remains attached to the protein of the skin when perfume is applied on the body. It evokes a surge of events in human immune system which results with allergic symptoms. Fragrance ingredients are leading cause that can be responsible for the occurrence of allergic contact dermatitis that is recently studied under cosmetic adverse reaction.

AIM

The aim of this review article was to define the allergies that are caused by fragrance ingredients. This review highlights the various aspects of perfume with respect to its manufacturing process, compositions, and fragrance ingredients identified as allergens and its present regulatory status.

METHOD

There area 175 frangrance ingredients that are used in perfumes cause allergic reaction. Several studies were conducted on the patients. The study was conducted on four fragrance markers in the baseline series: fragrance mix I (FM I), Myroxylon pereirae, fragrance mix II (FM II), and hydroxyisohexyl 3-cyclohexene carboxaldehyde.

RESULT

Around 658 patients showed allergy due to fragrance ingredients when the patch test was performed. In other study, out of 1253 patients, 90% of the FM I and M. pereirae detected 90% of the cases.

CONCLUSION

Majority of the fragrance ingredients can cause allergic reactions and hence act as allergens and thus increase the risk of sensitization on activation. If any individual suffers from allergy or contact dermatitis on use of any perfume, he/she should be aware of it and should reduce or avoid its use to overcome such problems of hypersensitivity.

Sensitization to Fragrance mix-1 in Patients with Contact Dermatitis in Nord-East of Italy: 1996–2016 Time Trend and Gender Effect

(1) Background: Fragrance sensitization is common in Italy and their constituents are used in many cosmetics and detergents. The objective of the study was to analyze the temporal trend of sensitivity to fragrance mix-1 in northeastern Italy and to evaluate gender differences; (2) Methods: From 1996 to 2016, 27,381 consecutive patients with suspected allergic contact dermatitis were patch tested. Individual characteristics were collected through a standardized questionnaire in six departments of dermatology or occupational medicine; (3) Results: The overall prevalence of sensitization to fragrance mix-1 was 7.3%; the prevalence was significantly higher in women (7.7%) than in men (6.3%). From 1996 to 2016, we observed an increase of this sensitization, ranging from 6.2% to 7.7% in males and from 7.2% to 9.1% in females; (4) Conclusions: Our study showed that contact allergy to fragrance mix-1 is important in both sexes and prevalence is increasing over time, despite the introduction of new fragrances with lower sensitization potential. There is the need to reduce the use of fragrances mix-1 to stop the increase of sensitization in exposed subjects.