500 SHORT COMMUNICATIONS

Allergy to perfume ingredients

C. D. CALNAN, ETAIN CRONIN AND R. J. G. RYCROFT

St. John's Hospital for Diseases of the Skin, 5 Lisle Street, Leicester Square,London WC2H 7BJ, England

For many years there has been discussion asto whether perfume or the fragrance ingredientof cosmetics was a rare or frequent cause ofreactions to cosmetics. Understandably cosme-tic chemists would often consider the perfumeresponsible for adverse reactions, probably forno other rational reason than that they didnot personally exercise any quality controlover the fragrance; while the perfumer tookthe opposite view for the reason that he didexercise control over the ingredients of thefragrance, because it was his special field ofexperience and expertise (Calnan 1976).

Most dermatologists have found it difficultif not impossible to identify an allergenic com-ponent of a perfume, because of the very largenumber of individual ingredients — often num-bering between one and two hundred. How-ever, the considerable energy and perseveranceof Larsen (1977) has now changed this situa-tion radically. With the full cooperation of aperfumery chemist, he has been able to identifyspecific allergens in fragrances.

Testing patients with each individual ingre-dient of a perfume is a long and tedious pro-cedure. They are usually only soluble in or-ganic solvents or oils such as liquid paraffin,olive oil or arachis oil. When these are usedfor carrying out patch tests to fifty or a hun-dred substances, the allergens frequently spreadin the skin surface lipid layer and producea diffuse reaction which is difficult to interpret.If, however, the ingredients are divided into asmall number of fractions and then furthersubdivided when a positive reaction is ob-tained, so many visits are required by the pa-tient that considerable perseverance is needed,and only the most determined physician andpatient can be expected to continue until afinal conclusion can be reached. Usually morethan a single reaction is obtained and the in-terpretation and relevance of reactions becomeincreasingly difficult. Larsen's experience istypical. In one patient he obtained 12 positivetests among 96 ingredients tested. He realisedthat many of these reactions must be eitherfalse positive or cross reactions.

However, he eventually found that, by par-

titioning many perfumes, there were only alimited number of 'pure' substances which gavespecific allergic reactions. From this he wasable to identify a series of eight substances;and surprisingly almost all cases of allergiccontact dermatitis to perfumes could be at-tributed to one or more of these eight chem-icals. From this he was able to ask a perfu-mery chemist to mix the substances into a'perfume mixture' to provide a screening testfor perfume allergy. The eight substances

Cinnamic alcohol HydroxycitronellalCinnamic aldehyde EugenolAmylcinnamic alcohol IsoeugenolOakmoss Geraniol

These eight substances were made up in amixture containing 2 % of each in petrolatum.

Initial experience with the mixture was veryfavourable in our clinic when used as an'aimed' patch test in selective patients. SinceJanuary 1979 we have incorporated this per-fume mixture into our standard patch testseries for eczematous patients and the resultsare presented here. In most cases when a posi-tive reaction was obtained the individual in-gredients were tested separately.

Posi- Per-January 1979-March 1980 Tested tive centPerfume mixture 2461 172 6Cinnamic aldehyde 94 4Cinnamic alcohol 61 2Isoeugenol 48 2Oakmoss 29 1.2Eugenol 25 1Geraniol 7 0.2Hydroxycitronellal 36 1.4Amylcinnamic alcohol 5 0.2

As was expected the highest number of posi-tive reactions was to cinnamic aldehyde. Amyl-cinnamic alcohol gave the lowest number. Thisis a rarely used perfumery chemical, but ispresent in the fragrance of Triadcortyl cream(Mycolog of Squibb Corp.) (Larsen 1979, Gold-

SHORT COMMUNICATIONS 501

berg 1972, Coskey & Bryan 1975). This frag-rance also contains oakmoss, hydroxycitronel-lal and cinnamic alcohol.

Isoeugenol is a much more frequent sensitizerthan eugenol. This result is in agreement withthe recent findings of Japanese workers' ani-mal experiments.

Although it is a mixture, our results indi-cate that perfumes are important allergens inour dermatitis patients in London. Most of thepositive reactions were relevant to the patient'spresent or past dermatitis. It is essential to in-clude this perfume mixture in our standardseries.

References

Calnan, C. D. (1976) Dermatocosmetic rela-tions. Journal of the Society of CosmeticChemists 27, 491.

Coskey, R. J. & Bryan, M. G. (1975) Allergiccontact dermatitis from the perfume in My-colog cream. Archives of Dermatology 111,131.

Goldberg, H. S. (1972) Allergic contact der-matitis from the perfume in Mycolog cream.Archives of Dermatology 105, 896.

Larsen, W. G. (1975) Cosmetic dermatitis to aperfume. Contact Dermatitis 1, 142—145.

Larsen, W. G. (1977) Perfume dermatitis: Astudy of 20 patients. Archives of Dermato-logy 113, 625-626.

Larsen, W. G. (1979) Allergic contact derma-titis to the perfume in Mycolog cream. Jour-nal of the American Academy of Derma-tology 1, 131-133.

Larsen, W. G. (1979) Sanitary napkin derma-titis due to a perfume. Archives of Derma-tology 115, 363.

Active sensitization to ortho and para-aminophenol with negative patchtest to meta-aminophenol

EDWARD RUDZKI, TERESA NAPIORKOWSKA AND ZDZISKAWA GRZYWA

Department of Dermatology, Warsaw Medical School, Koszykowa 82A,02-008 Warsaw, Poland

A man aged 23 worked at an auto servicetechnical school for 4 years and subsequentlyat an auto service station. After working therefor 1 year he developed dermatitis. He notedthat it was related to tires and other rubberproducts. When tested with the standard serieshe was positive to IPPD and PPD.

Several weeks later he was subjected topatch tests with 27 aromatic amines. After 48and 72 h all tests were negative. A week laterthe patient reported with a focal flare of thetest sites of ortho- and para-aminophenol, butthere was no such reaction at the site of meta-aminophenol. A repeat test with m-amino-phenol was again negative.

Although simultaneous sensitization to para-and meta-isomers of aromatic amines has beendescribed several times (Dungemann & Borelli1966, Kleniewska 1975, Rudzki et al. 1977), thepresent case confirms the theory of Mayer

(1954) that cross reactions occur only betweenthe ortho- and para-isomers of aromaticamines.

References

Dungemann, H. & Borelli, S. (1966) Untersu-chungen zur Gruppen-allergie bei aromati-schen Verbindungen. Berufsdermatoscn 14,281-295.

Kleniewska, D. (1975) Studies on hypersensi-tivity to the para group. Berufsdermatosen23, 31-36.

Mayer, R. L. (1954) Group sensitization tocompounds of quinone structure and its bio-chemical basis. Progress in Allergy, NewYork 4, 79-171.

Rudzki, E., Krajewska, D. & Grzywa, Z.(1977) Sensitivity to m-phenylenediamine.Berufsdermatosen 25, 85-88.