Prevalence of fragrance contact allergy in the general population of five European countries: a cross-sectional study.
BACKGROUND
Contact allergy to fragrances is assessed mostly in clinical populations of patients. Studies in the general population are scarce and vary in their methodology across countries.


OBJECTIVE
To determine the prevalence of fragrance contact allergy in the European general population and to assess the clinical relevance of positive patch test reactions to different fragrances.


METHODS
In five European countries (Germany, Italy, the Netherlands, Portugal and Sweden) a random sample from the general population aged 18-74 years was drawn. In total, 12 377 subjects were interviewed in this cross-sectional study and a random sample (n = 3119) was patch tested using the TRUE Test and Finn Chamber techniques. Patch test procedures were harmonized by mandatory training before the study and monitoring during the study.


RESULTS
The highest prevalence for contact allergy of 2·6% [95% confidence interval (CI) 2·1-3·2] was found for fragrance mix (FM) I in petrolatum, with a high content of atranol and chloratranol, followed by 1·9% (95% CI 1·5-2·4) for FM II in petrolatum. The conservatively estimated prevalence of fragrance contact allergy was 1·9% (95% CI 1·5-2·5). This is defined as the existence of a positive patch test to FM I or FM II; any of their individual materials; Myroxylon pereirae; sesquiterpene lactones or 3- and 4-hydroxyisohexyl 3-cyclohexene carboxaldehyde that show clinical relevance, defined conservatively as lifetime avoidance of scented products and an itchy skin rash lasting > 3 days in a lifetime. Using the reported lifetime prevalence of any contact dermatitis instead of the lifetime prevalence of any itchy skin rash, the prevalence is 0·8% (95% CI 0·5-1·2). The prevalence rates of contact allergy to fragrances in women are about twice those in men.


CONCLUSIONS
This study helps to identify targets for prevention of fragrance allergy.
Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstraße 3, 69115, Heidelberg, Germany.
T L
TL
Diepgen
Department of Social Medicine, Occupational and Environmental Dermatology, University Hospital Heidelberg, Thibautstraße 3, 69115, Heidelberg, Germany.
R
R
Ofenloch
Department of Occupational and Environmental Dermatology, University Hospital Malmö, S-20502, Malmö, Sweden.
M
M
Bruze
Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Via Garibaldi 13/15, 24122, Bergamo, Italy.
S
S
Cazzaniga
Occupational and Environmental, Dermatology Unit, State University Hospital, P.O. Box 30.001, NL-9700 RB, Groningen, the Netherlands.
P J
PJ
Coenraads
Klinik für Dermatologie und dermatologische Allergologie, Klinikum der FSU Jena, Erfurter Str. 35, D-07740, Jena, Germany.
P
P
Elsner
Clinica de Dermatologia, Hospital da Universidade Praceta Motal Pinto, Rua Infanta D.Maria, n 30-A-3D, P-3000-075, Coimbra, Portugal.
M
M
Goncalo
Department of Dermatology, University Hospital Malmö, S-20502, Malmö, Sweden.
Å
Å
Svensson
Department of Dermatology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Centro Studi GISED - FROM Presidio Ospedaliero Matteo Rota, Via Garibaldi 13/15, 24122, Bergamo, Italy.
L
L
Naldi
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000485:Allergens / Q000009:adverse effects; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D017449:Dermatitis, Allergic Contact / Q000453:epidemiology*; D004305:Dose-Response Relationship, Drug; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D010476:Perfume; D015995:Prevalence; D017678:Sex Distribution; D055815:Young Adult
D000485:Allergens; D010476:Perfume