Walter G. Larsen

Fragrance contact dermatitis: a worldwide multicenter investigation (Part II)

The purpose of this study was to determine the frequency of responses to selected fragrance materials in patients who were fragrance sensitive. 178 patients were evaluated in 8 centers worldwide with a fragrance mix (FM) and 20 other fragrance materials. Reaction to the fragrance mixture (FM) occurred in 78.7% of the subjects. Substances reacting at a rate of 2% or higher included jasmine absolute, geranium oil bourbon, l‐citronellol, spearmint oil, 1,3,4,6,7,8‐hexahydro‐4,6,6,7,8,8‐hexamethylcyclopenta‐γ‐2‐benzopyran, omega‐6‐hexadecenlactone, dimethyltetrahydrobenzaldehyde (isomer mixture), and α‐amylcinnamaldehyde. These chemicals should be furthur evaluated to corroborate their allergenicity. We are constantly looking for new fragrance allergens to extend the diagnostic capability of the fragrance mix (FM).

Fragrance contact dermatitis: A worldwide multicenter investigation (Part I)☆

OBJECTIVEnThe aim of this study was to determine the prevalence of responses to selected fragrance materials in patients with suspect fragrance allergy and to evaluate risk factors and associations with such responses. The validity of using specific fragrance ingredients versus a mixture of fragrances was evaluated in terms of predicting allergy to different fragrance ingredients.nnnMETHODSnOne hundred sixty-seven subjects were evaluated in seven centers worldwide with a fragrance mix, the eight ingredients in the fragrance mixture, six other well-known fragrance allergens, balsam of Peru, and 15 lesser studied fragrance materials.nnnRESULTSnThe age of the patients was 44.9 +/- 17.5 years (mean +/- SD). More than 85% were women. A relatively high proportion gave a past history of atopic disease. Facial eruptions (40%) and hand involvement (26.7%) were the most common topographic sites. All but 4 of the 35 fragrance materials produced a positive response in > 1%. A reaction to fragrance mix occurred in 47.3%. Seven of the 34 ingredients tested produced an allergic response in more than 10% of those tested. Men were more likely than women to exhibit a positive response to five fragrance ingredients. White persons were more likely to react to perfume mix (52.8% versus 25.3%) and certain ingredients in the mix than Asian persons. Allergy to benzyl salicylate was more common in Japan than in Europe or the United States.nnnCONCLUSIONnThe age at which patients with perfume allergy present for evaluation is similar to that of other contactants. Atopic individuals may be overrepresented in this group of patients. Face involvement is likely. White persons are more likely to react to fragrance mix, whereas in Asian patients benzyl salicylate was a more frequent allergen. Fragrance mix corrected with 85.6% of positive responses to fragrance ingredients. The addition of ylang ylang oil, narcissus oil, and sandalwood oil to fragrance mix would be expected to pick up 94.2% with positive responses to fragrance materials; adding balsam of Peru increases this to 96%.

Photoallergic contact dermatitis to men's perfumes.

Three patients with photosensitive eruptions related to the use of different mens perfumes were evaluated. We found that they were photoallergic to musk ambrette, an inexpensive, readily available synthetic perfume ingredient. Studies of cross‐reactivity with other perfumed colognes and after‐shave lotions suggest that musk ambrette is present in clinically significant concentration in large numbers of other cosmetic products.

A study of new fragrance mixtures.

OBJECTIVEnTo determine the frequency of responses to four mixtures of fragrance materials in routine clinic patients undergoing patch testing for suspect allergic contact dermatitis. The validity of using fragrance mixtures alone, or in combination, was evaluated in terms of predicting allergy to fragrance judged on the basis of finding a response to at least one of the fragrance mixtures.nnnMETHODSnA total of 752 subjects were patch tested in five centers worldwide with (1) fragrance mix 8% (FM), (2) balsam of Peru 25%, (3) a mixture of seven of the eight FM 8% ingredients and other fragrance ingredients including jasmine absolute (jasmine/FM mix), and (4) a mixture of five selected natural fragrance ingredients (NM).nnnRESULTSnOf 752 subjects, 100 (13%) had positive patch tests to at least one of the four fragrance mixtures. The age of the patients was 45.2 +/- 18.3 years (mean +/- SD). Ninety-six percent were Caucasian. Facial eruptions and hand involvement were the most common topographic sites. Of subjects exhibiting a positive response, 67% reacted to FM, 63% to the jasmine/FM mix, 47% to the NM, and 38% to balsam of Peru. Testing with FM and NM identified 84% of the perfume-allergic patients. FM 8% tested simultaneously with the jasmine/FM mix identified 86% of the perfume-allergic patients. Testing simultaneously with three test materials combining either the NM or the jasmine/FM mix with balsam of Peru and FM identified 95% of the perfume-sensitive patients.nnnCONCLUSIONSnThe simultaneous testing of NM or jasmine/FM mix, in addition to the conventional use of FM 8% and balsam of Peru, increases the sensitivity of testing for fragrance allergy from 81% to 95%.

multivariate Analysis of the Effect of Selected Factors on the Elicitation of Patch Test Response to 28 Common Environmental Contactants in North America

Standardized patch tests were performed on 3,974 patients between August 1, 1985 and July 31, 1989. Significant determinants of positive responses based on previously reported bivariate analysis of response were entered into a logistic regression model; the contribution of each factor to response to each of 27 test substances with which the patients were tested was evaluated. For 14 test substances, age increased the odds of response; nickel was striking in that increasing age decreased the odds of a positive response. Specific contactants were found to be associated with gender and topographical location of the eczematous dermatitis leading to the application of the patch tests. Atopic dermatitis was associated with a lower odds of response toP-phenylenediamine, but in no instance was associated with increased odds of a positive response.

Why is the USA the only country with compulsory cosmetic labeling

For the past 12 years, the USA has had cosmetic ingredient labeling, with its obvious beneficial effects for the consumer and physician. Why such a simple measure has not been adopted in other countries is difficult to comprehend. Cosmetic manufacturers who export cosmetics to the USA must label the ingredients of their cosmetics before they are imported into America. Cosmetic ingredient labeling came about in the mid-70s due to pressure from consumer groups and also legislative activity. The person most responsible for cosmetic labeling was a consumer lawyer, who petitioned the FDA in the early 1970s to interpret the Fair Packaging and Labeling Act of 1966 to apply to cosmetic ingredient labeling. At the same time, there was legislative activity in the Congress known as the Cosmetic Safety Act of 1973 (i.e., Eagleton Bill). This Act would have authorized the FDA to require cosmetic companies to register the plants, products, formulations, and adverse reaction data. It also would have required premarket testing of ingredients in cosmetics for safety. In addition, the special assistant to the President for consumer affairs was actively pursuing passage of the Cosmetic Safety Act. Hence, with all these pressures, the cosmetic industry accepted cosmetic ingredient labeling. In fact, some companies voluntarily labeled cosmetics before it became mandatory. At the time cosmetic ingredient labeling became mandatory, the Cosmetic, Toiletry, and Fragrance Association (CTFA) developed a dictionary of names to be used for cosmetic ingredient labeling. This proved to be an arduous task and took years to develop. We are currently using the 3rd edition. Trade secrets were a problem initiaiiy. However, if a firm can demonstrate factuaily to the FDA that an ingredient is a trade secret, then the name of the ingredient need not be put on the label but is indicated by the term other ingredient(s). To date, only a handful of ingredients have been accepted as trade secrets. Fragrances are simply listed on labels as fragrance without any further designation. Even though cosmetic companies are required to declare their ingredients on the label, a few problems remain. Professional products are exempt as they are used by beauticians, and cosmetic samples are unlabeled because they are not sold at retail. Paradoxically, topical over-the-counter medications and sunscreens are not labeled except for active ingredients. We are energetically trying to correct these oversights in labeling. Recently, the FDA has cracked down on wrinkle removers and cosmetics that promise reversal of aging. The FDA:s position is that if products claim to perform these functions, they are legally considered as drugs, and the manufacturer must prove that they are safe and effective as claimed before they are marketed.