Question of the Week

April 1, 2008


In 2007, "fragrance" was the allergen of the year.

"Fragrance allergy is the most common cause of cosmetic contact dermatitis. Many occult sources of fragrance exist. Those which cause the most concern are some 'fragrance-free' products that contain fragrance raw ingredients. Thus, the very patients requiring fragrance-free items may be exposed to potential perfume allergens or cross-reactors in seemingly safe products...."

When many think of avoiding fragrances, they think of avoiding perfume. In many cases, the fragrances that cause irritation are found added to other products such as lotions, soaps, and cleaning products--even if they are labeled as "fragrance-free."

"Contact dermatitis is an inflammation of the skin that results from direct contact with certain substances, such as soap, cosmetics, jewelry or weeds, including poison ivy or poison oak. The resulting red, itchy rash isn't contagious or life-threatening, but it can be very uncomfortable. Successful contact dermatitis treatment consists primarily of identifying what's causing the inflammation. Then, if you can avoid the offending agent, the rash usually resolves in two to four weeks."

Cosmetic dermatitis can be caused by many things, not just fragrances. While most people think to avoid poison oak or poison ivy because they know it will irritate their skin, many do not know what to avoid when it comes to cosmetics and fragrances. Both mislabeling and lack of labeling can lead to problems. Additionally, it can be difficult to know what is causing the problem and what should be avoided.

"Fragrances are complex substances. One perfume may contain hundreds of different chemicals. Trying to pinpoint specific fragrance allergens has challenged patch testers for years. The fragrance industry is both lucrative and competitive. The composition of a successful fragrance compound is an asset, which has led to a situation in which the fragrance industry is not always eager to disclose the chemicals it uses."

With companies not always willing to disclose exactly what is in their products, and fragrance-free products that have been found to contain raw ingredients that can cause irritation, what can a sensitive consumer do to keep reduce the chances that they will have a reaction?

"It is no longer sufficient to recommend the use of products labeled fragrance-free to fragrance-sensitive patients. These patients must be educated to read labels and look for plant extracts that are potential perfume sensitizers and cross-reactors. Rose oil, which has been felt to be a rare sensitizer, may be a more common allergen than previously recognized, perhaps because of its existence in a popular 'fragrance-free' soap and, conceivably, in many 'all-natural' products. Further testing with rose oil should be conducted in the future. Finally, manufacturers need to be more forthright in the labeling of their products."

While it is one thing for those who are sensitive to fragrance to read labels and be careful what products they put on their own skin, it is quite another for them to go out into the world and spend their days breathing in the scents of those around them who have used scented lotions, laundry detergents, hair sprays, soaps, deodorants, and perfumes.

"'Women have a stronger sense of smell than men. Certain ethnic groups have better abilities to smell,' Hirsch says. 'And there are also different physiological states that will intensify olfactory abilities, like when you're hungry or you're pregnant or if you have certain diseases or conditions.' Indoor smoking bans have also had an impact on our noses. 'People are no longer being inundated by smoke,' he says. 'They're aware of the ambient aromas around them and they're also more sensitized to them.' The problem is that what some consider ambient aromas, others perceive as a relentless chemical assault on their respiratory system.'"

While one person's lotion may not cause an irritation on another person's skin, it can still cause problems when inhaled by a scent-sensitive person.

"[A] 2003 study of more than 10,000 mothers and their infants in England found air fresheners, deodorants and aerosols were 'significantly associated' with headaches in moms and earache, vomiting and diarrhea in their babies."

In addition to headaches, fragrances have been found to trigger respiratory problems, as well.

"Respiratory impairment is a generic term that refers to a number of medical conditions that can affect the respiratory system and may result in limitations such as labored breathing or asthma attacks, fatigue and difficulty with mobility, heightened sensitivity to ordinary substances and chemicals, and compromised immunity to infection. ... The ADA [Americans with Disabilities Act] does not contain a list of medical conditions that constitute disabilities. Instead, the ADA has a general definition of disability that each person must meet (EEOC, 1992). Therefore, some people with respiratory impairments will have a disability under the ADA and some will not. ... [T]here have been several ADA cases involving people with respiratory impairments."

For some people whose ability to work is impaired by the fragrances of those around them, there are accommodations they can request.

"Employees who need accommodation can review the definition of disability and if they believe they meet the definition, they can proceed with their accommodation request. Employees may want to attach medical documentation to their accommodation request to show that they have an impairment (this usually means a diagnosis) and to show how the impairment limits them in their major life activities. ... Even if employees do not think that they meet the ADA's definition of disability, they may want to discuss accommodation needs with their employers anyway; some employers may choose to accommodate employees even if they do not meet the ADA definition of disability."

While some argue that their sensitivities to fragrances are so strong that they need those around them to eliminate scented products, others argue that it is simply a control issue where those with fragrances sensitivities are trying to tell others what to do. In fact, it may be a little bit of both.

"Hirsch, the smell expert, says seizing control of a smelly situation may actually be part of what makes scent sensitive people feel better. 'People perceive smells as an intrusion on their body space,' he says. 'But if you can control the smell, you're much less bothered by it than if you can't control it. It's an instinctive perception, like a dog marking its territory.' Hirsch says a person's perception of a smell will also change depending on whether it's coming from someone or something they like or not. 'You can clear a room with a bad smell and give people all kinds of headaches,' he says. 'But you can put that same smell on a Disney ride and no one will complain.'"

Questions of the Week:
What do those with fragrance allergies or sensitivities need to know when reading labels and choosing products? What challenges do they face when trying to find products they can safely use? What reasonable accommodations can those who react to fragrances expect those around them to make? When might there times when accommodations are refused? When might there times that accommodations should be suggested, but not required? When should accommodations be required? Regardless of the policies set up by the school or workplace, what can those who go to school (or work) with someone who has a fragrance allergy do to help create a healthier environment for that person?

Please email me with any ideas or suggestions.
Note: Due to increasing amounts of SPAM sent to this account, please include "QOW" in the subject line when sending me email.

I look forward to reading what you have to say.

Health Community Coordinator
Access Excellence @ the National Health Museum

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