Contact urticaria and its mechanisms

Con/act Dermatilis. /997. 36, This article reviews side-effects of fragrance materials present in cosmetics with emphasis on clinical aspects: epidemiology, types of adverse reactions, clinical picture, diagnostic procedures, and the sensitizers. Considering the ubiquitous occurrence of fragrance materials, the risk of sideeffects is small. In absolute numbers, however, fragrance allergy is common, affecting approximately 1% of the general population. Although a detailed profile of patients sensitized to fragrances needs to be elucidated, common features of contact allergy are: axillary dermatitis, dermatitis of the face (including the eyelids) and neck, well-circumscribed patches in areas of "dabbing-on" perfumes (wrists, behind the ears) and (aggravation of) hand eczema. Depending on the degree of sensitivity, the severity of dermatitis may range from mild to severe with dissemination and even erythroderma. Airborne or "connubial" contact dermatitis should always be suspected. Other less frequent adverse reactions to fragrances are photocontact dermatitis, immediate contact reactions and pigmentary changes. The fragrance mix, although very useful for the detection of sensitive patients, both causes false-positive and false-negative reactions, and detects only 70% of perfumeallergic patients. Therefore, future research should be directed at increasing the sensitivity and the specificity of the mix. Relevance is said to be established in 50-65% of positive reactions, but accurate criteria are needed. Suggestions are made for large-scale investigation of several fragrances on the basis of literature data and frequency of use in cosmetics. The literature on adverse reactions to balsam of Peru (an indicator for fragrance sensitivity), essential oils (which currently appear to be used more in aromatherapy than in perfumery) and on fragrances used as flavours and spices in foods and beverages is not discussed in detail, but pertinent side-effects data are tabulated and relevant literature is provided. Key words: perfume; fragrance; adverse reactions; fragrance mix; balsam of Peru; essential oils; allergic contact dermatitis; photosensitivity; immediate contact reactions; pigmented cosmetic dermatitis; occupational contact dermatitis. © Munksgaard, 1997. Accepted for publication 15 October 1996This article reviews side-effects of fragrance materials present in cosmetic products with emphasis on clinical aspects: epidemiology, types of adverse reactions, clinical picture, diagnostic procedures, and the sensitizers. Adverse reactions to balsam of Peru, a marker for fragrance sensitivity (!), which detects approximately 50% of patients allergic to fragrance materials (2), and to fragrances from non-cosmetic sources (e.g., flavours in food) are not discussed in detail. Essential oils seem to be more often used nowadays for medicinal (notably aromatherapy (3)) than for cosmetic purposes. Only the adverse reactions from their presence in cosmetic fragrances are included. However, because of their close relationship to fragr...

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“…When immediate contact reactions have occurred, appropriate tests should be performed (213)(214)(215)(216)(217)(218).…”

Section: Patch Testingmentioning

confidence: 99%

Adverse reactions to fragrances

Groot¹,

1997

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“…Many of the eliciting agents in this category may induce urticarial skin reactions via several mechanisms: direct release of histamine and other mediators from mast cells; direct effect on dermal vessels; release of vasoactive amines, acetylcholine, leukotrienes, and prostaglandins; and others (Cromwell, 1997;Hannuksela, 1997;Harvell et al, 1994;Lahti, 1980;Lahti et al, 1983;Nethercott et al, 1984).…”

Section: Nonimmunologic Contact Urticariamentioning

confidence: 97%

“…The consequences are potentially more serious than for nonimmunological contact urticaria (NICU) because reactions may not remain localized to the area of contact, and generalized urticaria, or even involvement of internal organs such as the respiratory or gastrointestinal tract, may follow, leading to anaphylactic shock (Amaro and Gossens, 2007;Hannuksela, 1997;Harvell et al, 1994;Wakelin, 2001). Even very small amounts of allergens can induce a reaction, and only selected (sensitized) individuals among the exposed persons are affected.…”

Section: Immunologic Contact Urticariamentioning

confidence: 98%

“…Plants, animal products, drugs, cosmetics, and industrial products may also be elicitors of ICU. Agents responsible for ICU reactions are mostly proteins, but other substances, such as low-molecular-weight agents (haptens), may cause IgE-mediated type I allergic reactions (Amaro and Gossens, 2007;Hannuksela, 1997;Harvell et al, 1994;Wakelin, 2001). The elicitating substance, penetrating through the skin or mucosal membrane, will react with two adjacent IgE molecules bound to the cell membrane of the mast cell (Sutton and Gould, 1997).…”

Section: Immunologic Contact Urticariamentioning

confidence: 99%

“…Even very small amounts of allergens can induce a reaction, and only selected (sensitized) individuals among the exposed persons are affected. ICU develops preferentially in persons with an atopic predisposition or atopic diseases (Harvell et al, 1994;Wakelin, 2001). The list of substances inducing proven or probable antigen-specific, IgE-mediated CU is considerable.…”

Section: Immunologic Contact Urticariamentioning

confidence: 99%

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