1. Patch testing with the European baseline series fragrance markers: A 2016 update
Chuin Ying Ung, Jonathan M.L. White, Ian R. White, Piu Banerjee and John P. McFadden
Guy’s and St Thomas’ University Hospital, St John’s Institute of Dermatology, London, U.K.
British Journal of Dermatology. DOI: /bjd.15949

2. Chuin Ying Ung, first author

3. Introduction What’s already known?
1.1- 8% of the general population have contact allergy to fragrance substances
Most centres in the UK screen for fragrance allergy by patch testing to Fragrance Mix I, Fragrance Mix II, Myroxylon pereirae and hydroxyisohexyl 3-cyclohexane carboxaldehyde (HICC)
These markers for fragrance allergy contain only half of the 26 fragrance substances required in the EU for labelling of cosmetic products

4. Methods
Retrospective review of patch test records of all eczema patients at St John’s Institute of Dermatology (London), patch tested with the European baseline series extended with the individual fragrance substances in
Patients’ awareness of previously reacting to fragranced products (fragrance history) were recorded as positive, uncertain and negative
Patch test reactions were recorded according to guidelines from the European Society of Contact Dermatitis

5. Results 2084 records of eczema patients reviewed
359 (17.2%, 95% CI 15.6%-18.9%) reacted to fragrance marker (FMI, FMII, Myroxylon pereirae or HICC) or at least one individual labelled fragrance substance
88 (15.8%) patients provided positive fragrance history; 1697 (81.3%) patients provided negative fragrance history; 47 (2.2%) patients provided uncertain fragrance history

6. Top ten allergens with positive patch test reactions

7. Concomitant reactions to fragrance mixes (FMI and FMII) and their individual constituents
Individual constituents of FMI
Concentration in European baseline series (%)
No. of patients with positive reactions (%, 95% CI)
Concomitant reactions with FMI (% of reactions to fragrance series allergen)
Evernia prunastri 2
36 (1.7, )
23 (63.9)
Cinnamyl alcohol
34 (1.6, )
20 (58.8)
Isoeugenol
31 (1.5, )
24 (77.4)
Cinnamal 1
24 (1.2, )
16 (66.7)
Hydroxycitronellal
22 (1.1, )
15 (68.2)
Eugenol
11 (0.5, )
10 (90.9)
Geraniol
10 (0.5, )
5 (50.0)
Amyl cinnamal
3 (0.1, )
3 (100.0)
Individual constituents of FMII
Concentration in European baseline series (%)
No. of patients with positive reactions (%, 95% CI)
Concomitant reactions with FMII (% of reactions to fragrance series allergen)
Hydroxylisohexyl-3-cyclohexne carboxaldehyde** 5
30 (1.4, )
27 (90.0)
Citral** 2
22 (1.1, )
13 (59.1)
Alpha-hexyl cinnammal** 10
7 (0.3, )
6 (85.7)
Farnesol**
5 (0.2, )
3 (60.0)
Citronellal** 1
2 (0.1, )
1 (50.0)
Coumarin**
1 (0.05, )
1 (100.0)

8. Proportion of positive reactions to individual fragrance substances detected by fragrance markers
Number of positive reactions to fragrance markers (pink) and individual fragrance allergens (blue) if oxidised limonene and oxidised linalool are included as fragrance markers
Number of positive reactions to current fragrance markers (pink) and individual fragrance allergens (blue)

9. Reliability of screening history for fragrance allergy
No. of patients who reacted to any fragrance marker or individual labelled fragrance substance
Positive patch test
Negative patch test
No. of patients who reported a positive fragrance history 88
242
No. of patients who reported a negative fragrance history
255
1442
No. of patients who reported an uncertain fragrance history 16 31

10. Discussion and conclusion What does this study add?
Contact allergy to fragrances is not usually identified by clinical history.
Current commonly used fragrance markers (FMI, FMII, Myroxylon pereirae, and HICC) detected only 40.8% (130 of 319) of patients reacting to any individual fragrance substance.
There are discrepencies in concomitant reactions to fragrance mixes (FMI and FMII) and their individual constituents which may be due to different concentrations used or combination of substances causing alterations in allergic or irritant thresholds.
Testing for fragrance allergy with all 26 individual fragrances that are labelled in cosmetic products is advocated

11. John McFadden, lead researcher

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