Fragrance

Fragrance is Allergen of the Year, and a very good choice it is. Fragrance mix I (FM I) is used in patch testing to diagnose the potential for clinical allergy. Allergens in this mix are found in 15 to 100% of cosmetic products (especially deodorants).¹ Reactions to FM I are the second to fifth most common patch-test reactions in series around the world. Testing FM I-allergic patients with ingredients of the mix is successful only about 50% of the time. Many of these FM I patch-test reactions are often weak, perhaps irritant, and hard to reproduce. Present clinical relevance for fragrance patch-test reactions has been claimed in the literature without acknowledging that conditions meeting the criteria for definite or probable relevance almost never occur and that even possible relevance is hard to call because investigators do not know what is in North American fragrances.⁷ New fragrance chemicals are constantly introduced. The fragrance mix II (FM II), developed by six European centers, has been well studied, and this should add more information for patients.¹² Reading reactions to FM II entails the same potential problems that were just mentioned in regard to FM I. In short, many persons are allergic to fragrances (ie, have positive patch-test reactions), but few of these individuals have clinical allergies to fragrances (allergic contact dermatitis). When we dermatologists advise our patients to avoid all fragranced products on the basis of a very weak positive (maybe irritant) fragrance mix patch-test reaction, we deprive them of one of life's pleasures. The effect of the new European Union labeling regulation will be watched with great interest. Certainly, patients with very strong product fragrance material use-test or patch-test reactions should be urged to use more caution when selecting scented products.⁵ Fragrance patch-test reactions remind dermatologists that they help their patients most when they critically evaluate patients' reactions and do their best to accurately ascertain clinical relevance. So much mystery still surrounds fragrances and perfumes that many people seek "natural" scents...and therein lies yet another story.².