Patch testing with a new fragrance mix detects additional patients sensitive to perfumes and missed by the current fragrance mix

• Published in: Contact dermatitis Vol. 52; no. 4; pp. 207 - 215
• Main Authors: Frosch, Peter J., Pirker, Claudia, Rastogi, Suresh C., Andersen, Klaus E., Bruze, Magnus, Svedman, Cecilia, Goossens, An, White, Ian R., Uter, Wolfgang, Arnau, Elena Giménez, Lepoittevin, Jean-Pierre, Menné, Torkil, Johansen, Jeanne Duus
• Format: Journal Article
• Language: English
• Published: Oxford, UK; Malden, USA Munksgaard International Publishers 01.04.2005; Blackwell
• Subjects: Acrolein - administration & dosage; Acrolein - adverse effects; Acrolein - analogs & derivatives; Adolescent; Adult; Aged; Aged, 80 and over; aldehyde; Aldehydes - administration & dosage; Aldehydes - adverse effects; Allergens - administration & dosage; Allergens - adverse effects; Allergic diseases; alpha-hexyl-cinnamic; Biological and medical sciences; citral; citronellol; Clinical Medicine; contact allergy; coumarin; Coumarins - administration & dosage; Coumarins - adverse effects; Cyclohexenes; Dermatitis, Allergic Contact - diagnosis; Dermatitis, Allergic Contact - etiology; Dermatologi och venereologi; Dermatology and Venereal Diseases; Dose-Response Relationship, Drug; farnesol; Farnesol - administration & dosage; Farnesol - adverse effects; Female; fragrance; fragrance mix; fragrances; Humans; Immunopathology; Klinisk medicin; Lyral; Lyral((R)); Male; Maximum Allowable Concentration; Medical and Health Sciences; Medical sciences; Medicin och hälsovetenskap; Middle Aged; mix; Monoterpenes - administration & dosage; Monoterpenes - adverse effects; patch testing; Patch Tests; Perfume - administration & dosage; Perfume - adverse effects; Sensitivity and Specificity; Skin allergic diseases. Stinging insect allergies; α-hexyl-cinnamic aldehyde; Cosmetic; Allergy; Skin disease; Flavoring agent; Coumarine derivatives; fragrance mix; fragrances; Food additive; Mixture; α-hexyl-cinnamic aldehyde; Skin test; Human; Immunopathology; Terpenoid; Perfume; coumarin; Aldehyde; patch testing; contact allergy; Contact dermatitis; Lyral; farnesol; Detection; citronellol; Citral; Patch
• ISSN: 0105-1873; 1600-0536
• DOI: 10.1111/j.0105-1873.2005.00565.x

The currently used 8% fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations – 28% FM II contained 5% hydroxyisohexyl 3‐cyclohexene carboxaldehyde (Lyral®), 2% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10%α‐hexyl‐cinnamic aldehyde; in 14% FM II, the single constituents' concentration was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5% of the patients. Positive reactions to FM II were dose‐dependent and increased from 1.3% (2.8% FM II), through 2.9% (14% FM II) to 4.1% (28% FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2% for FM I and means ranging from 1.8% to 10.6% for FM II. 8.7% of the tested patients had a certain fragrance history. Of these, 25.2% were positive to FM I; reactivity to FM II was again dose‐dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history – certain and none – values for sensitivity and specificity were calculated: sensitivity: FM I, 25.2%; 2.8% FM II, 8.1%; 14% FM II, 13.5%; 28% FM II, 17.6%; specificity: FM I, 96.5%; 2.8% FM II, 99.5%; 14% FM II, 98.8%; 28% FM II, 98.1%. 31/70 patients (44.3%) positive to 28% FM II were negative to FM I, with 14% FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FM I; the number of false‐positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14% FM II, seems to be the most appropriate diagnostic screening tool.