Delayed-Type Hypersensitivity to Fragrance Materials
Delayed-Type Hypersensitivity to Fragrance Materials
Background: In published reports from Europe, 3- and 4-(4-hydroxy-4-methylpentyl)cyclohexene-1-carboxaldehyde (HMPCC) (Lyral) has been described as a common cause of allergic contact dermatitis (ACD). In Europe, the rates of reaction to HMPCC among patients undergoing patch testing for suspected ACD have varied from 1.2 to 17.0%, depending on the country. Data on the incidence of sensitivity to HMPCC among North Americans with suspected ACD have not been reported.
Objectives: The goals of this study were (1) to assess the incidence of delayed-type hypersensitivity reactions to HMPCC among patients undergoing patch testing for evaluation of eczematous dermatitis at six centers throughout North America; (2) to determine the most appropriate concentration of HMPCC to use in performing patch tests; and (3) to compare and contrast the incidence rates for HMPCC hypersensitivity to those for other fragrance materials screened with the North American Contact Dermatitis Group (NACDG) screening tray, which includes fragrance mix, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, ylang ylang oil, jasmine absolute, and tea tree oil.
Methods: This report represents the prospective multicenter data on patients tested with the fragrance-related allergens on the NACDG standard screening tray and with HMPCC at 5%, 1.5%, and 0.5% concentrations in petrolatum. Statistical analyses were performed with Student's t-test (two tailed) and the chi-square test.
Results: Data from 1,603 patients evaluated at five US sites and one Canadian site were analyzed. Most patients (87.8%) were Caucasian. The majority (67%) were women, and 26.2% had a history consistent with atopic dermatitis. The patients ranged in age from 1 to 88 years, and the mean ± standard deviation was 46.3 ± 16.5 years. Myroxilon pereirae (balsam of Peru) and fragrance mix were the most frequent patch-test-positive fragrance allergens (6.6% and 5.9%, respectively). Cinnamic aldehyde (1.7%), ylang ylang oil (0.6%), jasmine absolute (0.4%), HMPCC (0.4% for 5% HMPCC, 0.3% for 1.5% HMPCC, and 0.2% for 0.5% HMPCC), and tea tree oil (0.3%) less frequently yielded positive reactions. Men were more likely than women to be allergic to cinnamic aldehyde. Women were more likely than men to be allergic to jasmine absolute. Atopic patients were no more likely to react to fragrance materials than were nonatopic patients. Patients who reacted to jasmine absolute tended to be older than the general population whereas those who reacted to tea tree oil tended to be younger than the general population. There were no other demographic differences between patients who reacted to a given fragrance material and the entire population studied. Testing with fragrance mix and balsam of Peru failed to identify the majority of patients in this study who were found to be sensitized to jasmine absolute, HMPCC, or tea tree oil.
Conclusion: HMPCC is an uncommon allergen in the North American population. We recommend testing with 5% HMPCC in petrolatum for those patients suspected of having a fragrance allergy.
Patch-test reactions to fragrance materials are common in North America. The fragrance mix used in standard screening allergen trays has only eight constituents, and testing with it does not identify all fragrance-allergic individuals. De Groot and colleagues estimated that about 15% of fragrance-allergic patients are not identified by patch-testing with the fragrance mix. In a worldwide multicenter study, Larsen and colleagues found that testing with fragrance mix correctly identified 85.6% of patients who had responses to the 31 individual fragrance ingredients tested. If ylang ylang oil, narcissus oil, and sandalwood oil had been added to the screening series, 94.2% of responses would have been detected in this study. Clearly, additional, noncross-reacting fragrance materials are present in the environment, and allergic responses to these go undetected even when fragrance mix is supplemented as described above.
Fenn reported that in 1989, 3- and 4-(4-hydroxy-4-methylpentyl)cyclohexene-1-carboxaldehyde (HMPCC) (Lyral, International Flavors & Fragrances Inc., Union Beach, NJ) was among the 25 most widely used fragrances in the United States. In a multicenter European study, the incidence of positive patch-test reactions to HMPCC was reported to range from 1.2% (in London) to 17.0% (in Leuven) among patients undergoing patch testing for eczematous dermatitis. Despite the high incidence rates reported from Europe, there have been no reports of allergic contact dermatitis from HMPCC in North America. However, it must be realized that HMPCC is not part of the fragrance mix in the TRUE Test system (Mekos Laboratories A/S, Hillerød, Denmark) approved by the Food and Drug Administration. Furthermore, even the North American Contact Dermatitis Group (NACDG, whose screening tray includes fragrance mix, Myroxilon pereirae [balsam of Peru], cinnamic aldehyde, jasmine absolute, ylang ylang oil, and tea tree oil) has not routinely screened for cutaneous hypersensitivity to HMPCC. Therefore, it is unknown whether this widely used fragrance ingredient is in fact a common sensitizer in the North American population. This report details the prevalence of delayed-type hypersensitivity to the fragrance ingredients found on the NACDG screening tray and to HMPCC among patients who are undergoing patch tests for the evaluation of suspected allergic contact dermatitis at six centers in the United States and Canada.
Background: In published reports from Europe, 3- and 4-(4-hydroxy-4-methylpentyl)cyclohexene-1-carboxaldehyde (HMPCC) (Lyral) has been described as a common cause of allergic contact dermatitis (ACD). In Europe, the rates of reaction to HMPCC among patients undergoing patch testing for suspected ACD have varied from 1.2 to 17.0%, depending on the country. Data on the incidence of sensitivity to HMPCC among North Americans with suspected ACD have not been reported.
Objectives: The goals of this study were (1) to assess the incidence of delayed-type hypersensitivity reactions to HMPCC among patients undergoing patch testing for evaluation of eczematous dermatitis at six centers throughout North America; (2) to determine the most appropriate concentration of HMPCC to use in performing patch tests; and (3) to compare and contrast the incidence rates for HMPCC hypersensitivity to those for other fragrance materials screened with the North American Contact Dermatitis Group (NACDG) screening tray, which includes fragrance mix, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, ylang ylang oil, jasmine absolute, and tea tree oil.
Methods: This report represents the prospective multicenter data on patients tested with the fragrance-related allergens on the NACDG standard screening tray and with HMPCC at 5%, 1.5%, and 0.5% concentrations in petrolatum. Statistical analyses were performed with Student's t-test (two tailed) and the chi-square test.
Results: Data from 1,603 patients evaluated at five US sites and one Canadian site were analyzed. Most patients (87.8%) were Caucasian. The majority (67%) were women, and 26.2% had a history consistent with atopic dermatitis. The patients ranged in age from 1 to 88 years, and the mean ± standard deviation was 46.3 ± 16.5 years. Myroxilon pereirae (balsam of Peru) and fragrance mix were the most frequent patch-test-positive fragrance allergens (6.6% and 5.9%, respectively). Cinnamic aldehyde (1.7%), ylang ylang oil (0.6%), jasmine absolute (0.4%), HMPCC (0.4% for 5% HMPCC, 0.3% for 1.5% HMPCC, and 0.2% for 0.5% HMPCC), and tea tree oil (0.3%) less frequently yielded positive reactions. Men were more likely than women to be allergic to cinnamic aldehyde. Women were more likely than men to be allergic to jasmine absolute. Atopic patients were no more likely to react to fragrance materials than were nonatopic patients. Patients who reacted to jasmine absolute tended to be older than the general population whereas those who reacted to tea tree oil tended to be younger than the general population. There were no other demographic differences between patients who reacted to a given fragrance material and the entire population studied. Testing with fragrance mix and balsam of Peru failed to identify the majority of patients in this study who were found to be sensitized to jasmine absolute, HMPCC, or tea tree oil.
Conclusion: HMPCC is an uncommon allergen in the North American population. We recommend testing with 5% HMPCC in petrolatum for those patients suspected of having a fragrance allergy.
Patch-test reactions to fragrance materials are common in North America. The fragrance mix used in standard screening allergen trays has only eight constituents, and testing with it does not identify all fragrance-allergic individuals. De Groot and colleagues estimated that about 15% of fragrance-allergic patients are not identified by patch-testing with the fragrance mix. In a worldwide multicenter study, Larsen and colleagues found that testing with fragrance mix correctly identified 85.6% of patients who had responses to the 31 individual fragrance ingredients tested. If ylang ylang oil, narcissus oil, and sandalwood oil had been added to the screening series, 94.2% of responses would have been detected in this study. Clearly, additional, noncross-reacting fragrance materials are present in the environment, and allergic responses to these go undetected even when fragrance mix is supplemented as described above.
Fenn reported that in 1989, 3- and 4-(4-hydroxy-4-methylpentyl)cyclohexene-1-carboxaldehyde (HMPCC) (Lyral, International Flavors & Fragrances Inc., Union Beach, NJ) was among the 25 most widely used fragrances in the United States. In a multicenter European study, the incidence of positive patch-test reactions to HMPCC was reported to range from 1.2% (in London) to 17.0% (in Leuven) among patients undergoing patch testing for eczematous dermatitis. Despite the high incidence rates reported from Europe, there have been no reports of allergic contact dermatitis from HMPCC in North America. However, it must be realized that HMPCC is not part of the fragrance mix in the TRUE Test system (Mekos Laboratories A/S, Hillerød, Denmark) approved by the Food and Drug Administration. Furthermore, even the North American Contact Dermatitis Group (NACDG, whose screening tray includes fragrance mix, Myroxilon pereirae [balsam of Peru], cinnamic aldehyde, jasmine absolute, ylang ylang oil, and tea tree oil) has not routinely screened for cutaneous hypersensitivity to HMPCC. Therefore, it is unknown whether this widely used fragrance ingredient is in fact a common sensitizer in the North American population. This report details the prevalence of delayed-type hypersensitivity to the fragrance ingredients found on the NACDG screening tray and to HMPCC among patients who are undergoing patch tests for the evaluation of suspected allergic contact dermatitis at six centers in the United States and Canada.
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