Suspected fragrance allergy requires extended patch testing to individual fragrance allergens

This study has been performed to evaluate the efficacy of fragrance mix (FM) as a screen for fragrance allergy. Patients were included if they had had positive allergic reactions to FM, to 1 of the 8 ingredients of FM, to 1 of 14 other fragrance materials, or to their own perfume. 91 patients were studied. There were 65 women and 23 men (in 3, their sex was not recorded) allergic to FM on patch testing. The mean (+/-SD) age was 48.4+/-18.6 years. 22 patients gave a past history of atopic eczema. Dermatitis of the hands (31%) and face (26%) were the most common presenting complaints. 85 patients (93%) had a positive allergic patch test reaction to FM. 22 of the 40 tested to the extended fragrance series were positive to other perfumes as well, and of these, there were 14 reactions (in 9 patients) to allergens not in the FM. In addition, 6 patients were positive only to separately tested fragrance constituents and not to the FM. In conclusion, FM is an accurate screen for fragrance contact sensitivity. However, patch testing to an extended series is needed if there is clinical suspicion of perfume allergy, as otherwise about 7% of patients allergic to fragrances will be missed.