Recommendation to include fragrance mix 2 and hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral) in the European baseline patch test series.
BACKGROUND
The currently used fragrance mix in the European baseline patch test series (baseline series) fails to detect a substantial number of clinically relevant fragrance allergies.


OBJECTIVE
To investigate whether it is justified to include hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral) and fragrance mix 2 containing hydroxyisohexyl 3-cyclohexene carboxaldehyde, citral, farnesol, coumarin, citronellol, and alpha-hexyl cinnamal in the European baseline patch test series.


METHODS
Survey of the literature on reported frequencies of contact allergy and allergic contact dermatitis from fragrance mix 2 and hydroxyisohexyl 3-cyclohexene carboxaldehyde (Lyral) as well as reported results of experimental provocation test.


RESULTS
Fragrance mix 2 has been demonstrated to be a useful additional marker of fragrance allergy with contact allergy rates up to 5% when included in various national baseline patch test series. Of the fragrance substances present in fragrance mix 2, hydroxyisohexyl 3-cyclohexene carboxaldehyde is the most common sensitizer. Contact allergy rates between 1.5% and 3% have been reported for hydroxyisohexyl 3-cyclohexene carboxaldehyde in petrolatum (pet.) at 5% from various European centres when tested in consecutive dermatitis patients.


CONCLUSIONS
From 2008, pet. preparations of fragrance mix 2 at 14% w/w (5.6 mg/cm(2)) and hydroxyisohexyl 3-cyclohexene carboxaldehyde at 5% w/w (2.0 mg/cm(2)) are recommended for inclusion in the baseline series. With the Finn Chamber technique, a dose of 20 mg pet. preparation is recommended. Whenever there is a positive reaction to fragrance mix 2, additional patch testing with the 6 ingredients, 5 if there are simultaneous positive reactions to hydroxyisohexyl 3-cyclohexene carboxaldehyde and fragrance mix 2, is recommended.
Bruze
Magnus
M
Department of Occupational and Environmental Dermatology, University Hospital, Lund University, Malmö, Sweden. magnus.bruze@med.lu.se
Andersen
Klaus Ejner
KE
Goossens
An
A
D000447:Aldehydes / Q000009:adverse effects; D000485:Allergens / Q000009:adverse effects; D053138:Cyclohexenes / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000175:diagnosis* / Q000453:epidemiology / Q000209:etiology / Q000473:pathology; D005060:Europe / Q000453:epidemiology; D006801:Humans; D010328:Patch Tests / Q000592:standards*; D010476:Perfume / Q000009:adverse effects
D000447:Aldehydes; D000485:Allergens; D053138:Cyclohexenes; D010476:Perfume; C092244:hydroxyisohexyl 3-cyclohexene carboxaldehyde