Fragrance Irritation and Allergies – Signs and symptoms

Fragrance Irritation and Allergies

Also called: Perfume Allergy, Fragrance Sensitivity, Perfume Sensitivity, Fragrance Allergy

Summary

Fragrances are found in a wide variety of different products including perfume, cologne, soap, candles, cosmetics, skin lotions and foods. The chemicals in fragrances can initiate or cause irritation or allergic reactions in sensitive people. Typical reactions to fragrances include breathing problems, asthma and contact dermatitis (an itchy and inflamed skin rash).

Reactions to fragrance may be an actual allergy, but they are usually simple irritation. It may be difficult to diagnose which is occurring. In addition, fragrances are composed of many different chemicals. This makes it difficult to identify if the sensitivity is to one particular chemical or to a combination of chemicals.

Once a person has developed fragrance irritation it is likely that the sensitivity will grow over time and with repeated exposure. Certain chemicals may be sensitizers at high levels of exposure and can result in sensitivity to the chemical at much lower levels after initial exposure.

The most effective way to prevent a reaction to fragrances in sensitive people is to avoid the offending substance. This can be challenging because manufacturers often do not list specific types and combinations of chemicals to protect their trade secrets.

People with pre-existing allergies may be prone to irritation to fragrances. Consulting a physician will help identify the type of reaction experienced and may provide information on how to relieve symptoms or avoid exposure to the product.

About fragrance irritation and allergies

Fragrances are found in a variety of commonly used perfumes, skin products, household products, foods, cosmetics and other substances. Many people use fragrances regularly without any ill effect, but for sensitive people, fragrances can cause a range of other reactions, including contact dermatitis (an itchy and inflamed skin rash), asthma, nasal congestion, cough, hives (raised bumps that appear on or beneath the skin) or eczema (inflammatory skin disease with lesions that usually appear very dry, thickened or scaly).

Contact dermatitis often occurs on and near the site where the product has been applied, such as the face, ears and neck. The hands and eyes may also be affected. Fragrances can be inhaled or ingested, and therefore can affect the lungs, nose, throat and mouth.

A reaction to fragrances does not necessarily mean a person is allergic to the product. Most cases of contact dermatitis (the most common reaction) are the result of a chemical reaction and not an allergic reaction involving the immune system. However, contact allergy to fragrances is increasing worldwide. Fragrances are the second most common contact allergens (after nickel). Contact allergens are substances that trigger allergic skin reactions in some people when they come in contact with the skin.

Fragrances are made from mainly synthetic organic chemicals. Little is known of the impact of fragrances on human health. The development of fragrances is both competitive and complex, and manufacturers are reluctant to disclose specific ingredients (or production methods) to protect their trade secrets. Furthermore, claims of adverse reactions to fragrances can be difficult to prove or to link to particular chemicals.

Irritant reactions to fragrances differ from allergies. In most allergic reactions, the body reacts to an allergen that it perceives as a harmful invader by triggering the cells of the body to release histamines and certain other chemicals. These chemicals then trigger allergy symptoms.

Unlike most allergens, fragrance materials are not protein-based, and they are generally too small to be detected by the body. Instead, they act as a hapten, binding with proteins in the skin. As they do so, they modify the proteins, causing the body to perceive the proteins as a foreign substance, thus triggering a reaction.

Some fragrance materials are absorbed intact into the body and remain that way. Others are broken down into compounds. The reaction may be to the entire material, or to one or more of its compounds. Sometimes, light breaks down these materials, resulting in a photosensitive reaction due to the light exposure.

Once a person has developed fragrance irritation it is likely that the sensitivity will increase with time and with repeated exposure. Certain chemicals may be sensitizers at high levels of exposure and can result in sensitivity to the chemical at much lower levels after initial exposure.

Fragrance irritation potentially affects not only the person wearing the fragrance, but anyone who comes into contact with that person and is exposed to the substance.

Potential causes of fragrance reactions

Thousands of chemicals are used in fragrances, but only a few actually cause the majority of irritations or allergies. These include:

  • Cinnamic alcohol
  • Cinnamic aldehyde
  • Eugenol
  • Isoeugenol
  • Geraniol
  • Alpha amyl cinnamic alcohol
  • Hydroxycitronellal
  • Oak moss absolute

A number of other chemicals are used to manufacture scented products. These chemicals may also produce allergic reactions or irritate the skin or respiratory tract. Common chemicals used in fragrances include:

  • Acetone
  • Alpha-pinene
  • Alpha-terpineol
  • Benzyl acetate
  • Benzyl alcohol
  • Benzaldehyde
  • Camphor
  • Ethanol
  • Ethyl Acetate
  • g-Terpinene
  • Limonene
  • Linalool

Fragrance is found in a wide variety of regularly used products including perfumes, laundry detergents, health products, feminine hygiene products, soap, hair products (e.g., shampoo, conditioner), deodorants, body creams, cosmetics, toothpaste, mouth wash, insecticides, tissues (scented toilet paper), essential oils, incense, candles, deodorizers and even food (e.g., ice cream, chewing gum, baked goods, soft drinks). Any of these products may trigger a response in a person with a sensitivity or allergy to fragrance.

“Unscented,” “natural” and “organic” products are not necessarily free of fragrance. Many of these products contain chemicals to disguise product odors and may trigger a reaction in sensitive people. All products that may contain fragrance should be avoided by sensitive people in order to prevent irritation or allergic reaction.

In some cases, a particular chemical odor may be severely unpleasant and cause a person to think they are experiencing an allergic reaction. There is a strong tie between the sense of smell and emotion. Research indicates that foul odors may make people think their health is impacted when the offending substance is ultimately not harmful. Without an actual physical response to a fragrance that triggers an allergic reaction, the offending odor is likely not damaging, just annoying.

Related allergies and conditions

Fragrance irritation or allergies are related to four types of physical reaction:

  • Contact dermatitis. A localized rash or irritation of the skin that is caused by contact with a substance. There are two types:

    • Allergic contact dermatitis results from a reaction of the immune system to an allergen. Fragrances are one of the most common triggers of allergic contact dermatitis.

    • Irritant contact dermatitis results from coming into contact with a substance that irritates the skin, such as a chemical in some fragrances. It takes a larger amount over a longer period of time for an irritant to cause dermatitis than an allergen.

  • Eczema. A skin condition that is triggered by a substance. Dry flaky skin appears over red, inflamed areas, causing intense itching and burning. People with eczema are most likely to develop contact dermatitis. Eczema caused by allergies may be called atopic dermatitis.

  • Hives. Red, swollen patches of skin that occur in groups and may burn, sting or itch. These are caused by an allergic reaction that causes blood plasma (the fluid portion of blood) to leak into the skin.

  • Asthma attacks. A condition in which the airways become blocked or narrowed, causing shortness of breath and difficulty breathing. Fragrance irritation or allergies may trigger an asthma attack.

All four of these reactions may be caused by any number of different substances. A physician can determine whether a patient is experiencing an irritation to a fragrance, sensitivity or an actual allergy. Effective treatment requires identifying the source and nature of the reaction.

People with sensitivity to fragrances may also experience sensitivity to cosmetics, detergents, cleansers, deodorizers and other substances that release chemicals into the air. Studies have indicated that people with pre-existing nasal allergies like hay fever perceive or react more strongly to irritant chemicals. 

Other conditions related to fragrance irritation or allergies include:

  • Multiple chemical sensitivity (MCS). MCS is a controversial condition in which exposure to a variety of indoor air pollutants, including fragrances, is believed to cause “allergic” reactions in a small group of highly sensitive people. Some proponents of this theory suggest that it is a new and uncommon form of allergy. Others suggest that it is a stress-related psychosomatic disorder. Psychosomatic disorders are conditions in which emotional factors aggravate physical symptoms. Similar conditions include sick building syndrome which refers to multiple complaints of acute symptoms of irritation and allergy when in a specific building, but then disappear when the person leaves. Single causes of irritation are seldom identifiable in both MCS and sick building syndrome.

  • Occupational rhinitis. An episodic, work-related occurrence of sneezing, nasal discharge and obstruction due to natural or synthetic causes.

  • Occupational asthma. A common form of industrial lung disease, this form of asthma is triggered by exposure to dust, vapors, gases, fumes or other irritants at a patient’s workplace.

Specialists have found that many people who experience reactions to fragrances are not actually allergic to the chemicals in these products. Instead, the chemicals are irritants, which are generally less responsive to treatment than allergies. Avoiding the offending chemical appears to be the only effective solution, since allergy medications will not affect symptoms of fragrance irritation.

Signs and symptoms of fragrance reaction

Fragrances can enter the body through inhalation, ingestion or absorption. The first indicator of a fragrance irritation or allergy is usually a skin rash after the use of a perfume, cream or lotion. Reactions can also take other forms, including:

  • Hives (smooth, raised pink or white bumps that appear on or beneath the skin)

  • Nausea or dizziness

  • Headache

  • Itchy skin, eyes and nose

  • Runny nose

  • Wheezing (whistling or high-pitched sound that results when breathing tubes are narrowed or obstructed)

  • Coughing

  • Eczema (inflammatory skin disease with lesions that usually appear very dry, thickened or scaly)

  • Difficulty breathing

  • Sore throat

  • Asthma attacks or asthma-like symptoms

  • Strange tastes in the mouth

The severity of symptoms varies from one individual to another. Symptoms can develop anywhere from a few minutes to seven to 10 days after exposure.

Diagnosis methods for fragrance reactions

The diagnosis of fragrance allergies begins with a physical examination. The physician will ask questions to determine the origin of the condition. The patient’s medical history will be reviewed and pre-existing medical conditions identified.

An allergy skin test may be performed to identify the specific chemical(s) causing the reaction. A skin test is a fast, simple test that involves placing a substance on or just under the skin to provoke a reaction. The test is positive when the skin reddens and swells.

It may be difficult to diagnose the specific chemical or chemical compound to which an individual is sensitive or allergic. Fragrance formulas are often trade secrets and companies guard the specific formulas to protect their intellectual property.

Because symptoms of fragrance allergies can be the same as a fragrance irritation, it can be difficult to tell these conditions apart. Often a diagnosis of fragrance irritation is made only after a fragrance allergy is ruled out as a cause of symptoms.

Treatment and prevention

The best way to prevent a reaction to fragrance is to avoid the offending substance. Discussing the fragrance irritation or allergy with people at work and at home will help to limit exposure to other people’s fragrances.

Careful examination of product labels is important for people with fragrance irritations or allergies. A product labeled “unscented” does not mean it is fragrance-free, but merely that it has no perceptible scent. A fragrance may have been added to the product to mask scent. While such a trace amount of fragrance is unlikely to cause irritation, it may trigger allergic reactions in people with fragrance allergies.

Fragrances added to products to mask scent do not have to be labeled as ingredients. A label that is marked “perfume free” or “fragrance free” is more likely to contain no fragrances. Sensitive people may wish to consult a dermatologist for recommendations on fragrance free skin products, or an allergist for recommendations on avoiding a variety of scented products.

When using a product for the first time, patients may benefit from performing a “patch test.” This involves applying a small amount of the product to a symptom-free section of skin on the forearm, twice a day, for five days. Products that fail to produce symptoms during the testing period are less likely to produce symptoms with continued use. It is important to note that patch tests should only be performed with products that are intended to remain on the skin for an extended period of time, such as lotions and cosmetics. Patients should discuss patch tests with their physician before performing them.

Treatment of fragrance reactions are related to the nature and severity of the symptoms.. Hives, runny nose and itchy eyes may be treated with oral medications, such as antihistamines. These drugs block the work of histamine, a chemical released during allergic reactions. Breathing problems or asthma-like symptoms may be treated with inhaled bronchodilators, which open breathing passages.

For any skin rashes related to fragrance reactions, it is important for patients to keep the skin clean, dry and protected to avoid further break down of irritated skin and prevent infection. Applications of corticosteroid cream may be helpful in treating rash or itchiness.

The only way to completely prevent a fragrance reaction is for sensitive people to avoid the problem substance. However, avoidance is not always possible. For people with fragrance allergies, allergy shots (immunotherapy) may help reduce or prevent the occurrence of allergy symptoms. Allergy shots increase the patient’s tolerance to a substance through periodic injections of small, but increasing amounts of the substance. They are not effective in treating fragrance irritation or non-allergy related symptoms.

Patients need to be aware of the numerous chemicals that may cause fragrance reaction. Sensitive people should consult with their physicians for recommendations and appropriate medications, as well as ensure adequate ventilation and filtration processes in their homes.

Fragrances can be circulated through air conditioning. Therefore, HEPA filters may be useful for people with fragrance allergies. HEPA (high efficiency particulate air) filters are highly effective air filters that remove particles from the air by forcing air through screens with microscopic pores. This makes them effective at reducing the number of allergens (substances that trigger allergic reactions) and asthma triggers (e.g., dust, pollen, mold, dander, tobacco smoke) in an enclosed space. Originally designed for industrial, medical and military use, HEPA filters are now being used to clean the air in individual homes and offices.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctors the following questions related to fragrance irritation and allergies:

  1. Do my symptoms indicate a fragrance allergy?

  2. What tests will you use to determine if I have fragrance intolerance or fragrance allergies?

  3. Do fragrance allergies pose a danger to my overall health?

  4. What treatment options are available to me? Am I candidate for allergy shots?

  5. What terms should I look for when reading a product label? Are “unscented” products safe to use?

  6. Are there certain types of products I should avoid?

  7. Can you recommend products that are safe for me to use?

  8. Should I perform a patch test before using a new skin product?

  9. Would I benefit from placing a HEPA filter in my home?

  10. Are my children more likely to develop fragrance allergies or irritation because I am affected?
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