title: Patch testing with a new fragrance mix detects additional patients sensitive to perfumes and missed by the current fragrance mix.
abstract: The currently used 8% fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations - 28% FM II contained 5% hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral), 2% citral, 5% farnesol, 5% coumarin, 1% citronellol and 10%alpha-hexyl-cinnamic aldehyde; in 14% FM II, the single constituents' concentration was lowered to 50% and in 2.8% FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances: certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5% of the patients. Positive reactions to FM II were dose-dependent and increased from 1.3% (2.8% FM II), through 2.9% (14% FM II) to 4.1% (28% FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2% for FM I and means ranging from 1.8% to 10.6% for FM II. 8.7% of the tested patients had a certain fragrance history. Of these, 25.2% were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1% to 17.6% in this subgroup. Comparing 2 groups of history - certain and none - values for sensitivity and specificity were calculated: sensitivity: FM I, 25.2%; 2.8% FM II, 8.1%; 14% FM II, 13.5%; 28% FM II, 17.6%; specificity: FM I, 96.5%; 2.8% FM II, 99.5%; 14% FM II, 98.8%; 28% FM II, 98.1%. 31/70 patients (44.3%) positive to 28% FM II were negative to FM I, with 14% FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FM I; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14% FM II, seems to be the most appropriate diagnostic screening tool.
authors.affiliation: Department of Dermatology, Klinikum Dortmund gGmbH and University of Witten/Herdecke, Dortmund, Germany. peter.frosch@klinikumdo.de
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Frosch
authors.forename: Claudia
authors.initials: C
authors.lastname: Pirker
authors.forename: Suresh C
authors.initials: SC
authors.lastname: Rastogi
authors.forename: Klaus E
authors.initials: KE
authors.lastname: Andersen
authors.forename: Magnus
authors.initials: M
authors.lastname: Bruze
authors.forename: Cecilia
authors.initials: C
authors.lastname: Svedman
authors.forename: An
authors.initials: A
authors.lastname: Goossens
authors.forename: Ian R
authors.initials: IR
authors.lastname: White
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Uter
authors.forename: Elena Giménez
authors.initials: EG
authors.lastname: Arnau
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Lepoittevin
authors.forename: Torkil
authors.initials: T
authors.lastname: Menné
authors.forename: Jeanne Duus
authors.initials: JD
authors.lastname: Johansen
mesh_terms: D000171:Acrolein / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D000080462:Acyclic Monoterpenes; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000447:Aldehydes / Q000008:administration & dosage / Q000009:adverse effects; D000485:Allergens / Q000008:administration & dosage / Q000009:adverse effects; D003374:Coumarins / Q000008:administration & dosage / Q000009:adverse effects; D053138:Cyclohexenes; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000209:etiology*; D004305:Dose-Response Relationship, Drug; D005204:Farnesol / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D006801:Humans; D008297:Male; D008452:Maximum Allowable Concentration; D008875:Middle Aged; D039821:Monoterpenes / Q000008:administration & dosage / Q000009:adverse effects; D010328:Patch Tests; D010476:Perfume / Q000008:administration & dosage / Q000009:adverse effects; D012680:Sensitivity and Specificity
chemical_list: D000080462:Acyclic Monoterpenes; D000447:Aldehydes; D000485:Allergens; D003374:Coumarins; D053138:Cyclohexenes; D039821:Monoterpenes; D010476:Perfume; C080043:hexyl cinnamic aldehyde; D005204:Farnesol; D000171:Acrolein; C030123:coumarin; C007078:citronellol; C092244:hydroxyisohexyl 3-cyclohexene carboxaldehyde; C007076:citral