Threshold responses in cinnamic-aldehyde-sensitive subjects: results and methodological aspects

Cinnamic aldehyde is an important fragrance material and contact allergen. The present study was performed to provide quantitative data on the eliciting capacity of cinnamic aldehyde, to be considered in assessment of clinical relevance and health hazard. The skin response to serial dilution patch tests and 6-week graded use tests with 0.02, 0.1 and 0.8% cinnamic aldehyde in ethanol was studied in a group of cinnamic-aldehyde-sensitive eczema patients. The minimum effect level demonstrated was 0.02% cinnamic aldehyde on patch testing and 0.1% cinnamic aldehyde on use testing, which are allowed usage concentrations in different kind of cosmetics. 72% (13/18) developed eczema in the use test performed with an alcoholic solution of cinnamic aldehyde on healthy upper arm skin. 6 of the 13 use-test-positive subjects (46%) reacted later than day 7, indicating that the standard exposure period of 7 days in use testing may not be sufficient, if low concentrations or volatile substances are used. A significant correlation between patch test sensitivity and the outcome of use testing was found (1,<0.001), which should be considered in designing future use test studies and advising patients. Detailed exposure information is needed to evaluate more fully the consequences of cinnamic aldehyde sensitivity.