Fragrance Allergies Uncovered: A Dermatologist's Deep Dive

This is an article on perfume allergies written by Dermatologist Dr. Mahwish Abbasi

From cosmetics and perfumes to cleaning supplies for the home, our everyday lives are filled with fragrances. These fragrances are known to cause allergic reactions in susceptible individuals. Even though they frequently elicit pleasant feelings, allergic reactions can range from minor irritation to extreme discomfort. People with sensitive skin or underlying medical disorders like asthma or eczema are greatly concerned about fragrance allergies. We will be discussing the definition of fragrance allergies, its causes, symptoms, and management strategies in this article.

What Does It Mean to Have an Allergic Reaction to Fragrance?

When our immune system identifies any molecule as a foreign body, it initiates an allergic response which sets off the release of histamines and other chemical compounds that induce irritation and inflammation in the body.[1]

Haptens are small molecules that attach to proteins of the skin to form complexes that the immune system perceives as foreign.[2] Fragrance molecules act as these haptens, causing a detrimental effect on the immune system and unpleasant skin symptoms which include:

• Irritation: felt as burning, stinging, or redness.
• Rash: seen as lumps or spots that are elevated and irritated.
• Contact Dermatitis: characterised by dry, scaly, or blistering skin, brought on by direct contact with an allergen. [3]

Allergies of any kind evolve over time and same applies to fragrance allergies. You might have been using the same product all your life without experiencing any problems, repeated exposure to allergens sensitise the immune system, causing an allergic reaction. Sensitisation is what causes people to acquire sensitivities and allergies to products they have used for a years.[4]

Symptoms of Fragrance Allergy

The symptoms of a fragrance allergy can vary depending on the individual and the severity of the reaction. Common signs include:

• Skin redness, itching, or swelling.
• Hives or rashes.
• Watery or itchy eyes.
• Sneezing, nasal congestion, or runny nose.
• Headaches or migraines.
• Worsening of respiratory conditions like asthma. [5]

In severe cases, exposure to fragrances can lead to anaphylaxis (a rapid, severe allergic reaction that can cause breathing difficulties, swelling, and a drop in blood pressure, requiring immediate treatment), though this is rare.[6] 

People with multiple chemical sensitivities (MCS) can exhibit systemic symptoms which can include but may not be limited to gastrointestinal problems, migraines, exhaustion, and even brain fog. Although less frequent, such reactions signpost towards the impact fragrance allergies can have on general health.[7]

How Do Fragrances in Cosmetics Contribute to Allergic Reactions?

Cosmetics are one of the most common sources of fragrance allergens. Fragrances are added to products like moisturisers, shampoos, and make-up to enhance their appeal. However, these fragrances often contain synthetic or natural compounds that can irritate the skin or trigger allergic reactions.[8] 

For example, fragrances in cosmetics can penetrate the skin’s barrier, especially if the skin is already compromised (e.g., due to dryness or eczema). This makes individuals more susceptible to developing contact dermatitis or other allergic reactions.[9] 

A lesser-known fact is that even products labelled “unscented” may contain masking fragrances to neutralise odours. These masking agents can still trigger allergic reactions in sensitive individuals. If potentially susceptible, one must always look for products labelled “fragrance-free” to minimise the risk.[10]

Fragrance allergies are more common than many people realise. In the UK, it’s estimated that 1 in 5 people suffer from some form of fragrance sensitivity.[11] For these individuals, exposure to fragrances can have a significant impact on their quality of life, including: 

• Frequent migraines or headaches.  
• Skin discomfort, leading to reduced self-esteem.  
• Worsening of respiratory conditions like asthma.  
• Increased sick days due to severe reactions. [12]

The widespread use of fragrances in public spaces, workplaces, and personal care products makes it challenging for those with allergies to avoid triggers.[13]

A study published in the Journal of the European Academy of Dermatology and Venereology found that fragrance allergies are one of the leading causes of contact dermatitis worldwide.

The study also highlighted that women are more likely to develop fragrance allergies due to higher exposure to scented products like cosmetics and perfumes.[14]

FREE PDF: 
Download a list of 100+ Fragrance and Balsam of Peru Ingredient Names to Avoid in Cosmetics

What Are Linalool and Limonene Allergies?

Linalool and limonene are two common fragrance compounds found in many cosmetics and household products. While they are naturally occurring (often derived from citrus fruits and lavender), they can oxidise when exposed to air, forming allergens that trigger reactions.[15]

• Linalool: Found in lavender, coriander, and bergamot, linalool is a common cause of contact dermatitis.[16]
• Limonene: A citrus-scented compound used in cleaning products and cosmetics, limonene is another frequent allergen. [17]

Both compounds are often listed on ingredient labels, but their oxidised forms are not, making it difficult for consumers to identify potential triggers,[18] which is why products containing these ingredients may not cause issues initially but can become problematic over time.[19]

Did you know grapefruit essential oil can contain up to 85% limonene? 

Why Do Essential Oils Trigger Fragrance Allergies?

Essential oils, often marketed as natural alternatives to synthetic fragrances, can also cause allergic reactions. This happens because plants do have chemicals that can cause skin irritation and immunological reactions.[20] For example, individuals often develop contact dermatitis after using tea tree oils, lavender oils, and eucalyptus oils.[21]

Essential oils are considered safer as they are “natural” but they tend to cause more irritation and intense reactions as they have a high content of volatile organic compounds (VOC). As the laws and regulations are laxer for essential oil composition, it can vary, raising the possibility of allergic reactions to unknown chemicals and their breakdown products.[22]

What Is Balsam of Peru Allergy? 

The Balsam of Peru is a natural resin made from tree bark which is frequently used in cosmetics, fragrances, pharmaceuticals, and cosmeceuticals. It contains various potentially allergenic substances, including cinnamic acid and benzoic acid.

Anyone with an allergy to Balsam of Peru may get skin reactions, respiratory problems, and even gastrointestinal symptoms if exposed.[23] Citrus fruits, tomatoes, and spices like cinnamon and vanilla contain Balsam of Peru. This means that such individuals may need to stay away from any products or food containing Balsam of Peru.[24]

Is Perfume Intolerance the Same as Perfume Allergy?

Although used interchangeably, perfume intolerance and perfume allergy are not the same. A perfume allergy results in symptoms like rashes or breathing problems induced due to an immunological reaction.[25] Perfume intolerance, on the other hand, is a non-allergic sensitivity without an immunological response characterised by headaches, nausea, or lightheadedness.[26] 

Unlike the immunological system in perfume allergy, the neurological system is implicated in perfume intolerance. Strong smells, for instance, have the potential to overstimulate the olfactory nerves, resulting in nausea or migraines. For this reason, some people who do not actually have an allergy may feel ill in strongly perfumed situations.[27]

Is There a Cure for Fragrance Allergy?

Fragrance allergies do not currently have a cure. Avoiding exposure to recognised allergies is the recommended course of action. Emollients, topical corticosteroids, and antihistamines are a few examples of management options that can help control symptoms.[28] Although it is not frequently used for scent allergies, allergy immunotherapy may be suggested in some situations.[29]

New studies are looking into how gut health and probiotics may help treat allergic diseases. Maintaining a healthy gut flora may help modify immune responses and lessen overall sensitivity, even though this is not yet a proven treatment for scent allergies.[30]

What Should You Avoid if You Have a Fragrance Allergy?

If you suffer from a fragrance allergy, consider the following steps: 

1. Switch to Fragrance-Free Products: Look for products labelled “fragrance-free” or “unscented.” Be cautious with “natural” products, as they may still contain allergenic essential oils.[31] 
2. Read Ingredient Labels: Avoid products containing linalool, limonene, Balsam of Peru, and other common allergens. [32]
3. Patch Testing: In the UK, patch testing is recommended for individuals with suspected fragrance allergies. To find particular triggers, tiny quantities of possible allergens are applied topically to the skin to find particular triggers. [33]
4. 4. Avoid Scented Products: Steer clear of scented candles, hair mists, air fresheners, and sleep sprays as they may emit volatile organic compounds (VOCs) that cause responses. [34]

Conclusion

Although fragrance allergies can have a major negative influence on a person's quality of life, symptoms can be lessened and triggers can be avoided with appropriate management. People can make educated decisions about the items they consume and take precautions for their health by being aware of the signs and causes of scent allergies.

For testing and individualised guidance, see a dermatologist or an allergist if you think you may have a scent allergy. Making the switch to fragrance-free goods and paying close attention to ingredient labels can have a profound impact.

References

[1] Johansen et al., *Fragrance Contact Allergy*, 425-432.[2] Basketter et al., *Fragrance Allergy*, 189-192.  [3] Fisher, *Contact Dermatitis*, 45. [4] Uter et al., *Contact Allergy to Fragrances*, 137-143. [5] Saini and Bindslev-Jensen, *Allergic Contact Dermatitis to Fragrances*, 479-486. [6] Scheinman, *The Allergic Contact Dermatitis Syndrome*, 621-628.  [7] British Association of Dermatologists, *Contact Dermatitis: Fragrance Allergy*.[8] National Eczema Society, *Fragrance and Skin Sensitivity*.[9] Asthma UK, *Fragrances and Respiratory Health*.[10] Frosch et al., *Contact Dermatitis*, 120.[11] Johansen, *Fragrance Contact Allergy*, 789-798.[12] Schnuch et al., *Contact Allergy to Fragrances*, 254-261.[13] De Groot and Frosch, *Adverse Reactions to Fragrances*, 57-86.[14] Heisterberg et al., *Contact Allergy to Fragrances in Denmark*, 266-272.[15] Politano and Api, *Fragrance Material Review on Linalool*, S160-S170.[16] Politano and Api, *Fragrance Material Review on Limonene*, S171-S177.[17] Karlberg et al., *Air Oxidation of Linalool*, 209-216.[18] Matura et al., *Oxidized Limonene and Linalool*, 247-253.[19] Sköld et al., *Contact Allergy to Resin Acids*, 95-100.[20] De Groot and Schmidt, *Essential Oils*, 45.[21] Hagvall et al., *Contact Allergy to Essential Oils*, 265-272.[22] Tisserand and Young, *Essential Oil Safety*, 120.[23] Warshaw et al., *Contact Dermatitis Associated with Balsam of Peru*, 110-117.[24] Scheman et al., *Food Avoidance Diets*, 248-256.[25] Frosch and Johansen, *Allergic Contact Dermatitis to Fragrances*, 189-199.[26] Millqvist, *Provocations with Perfume*, 544-546[27] Johansen et al., *Perfume Intolerance*, 273-280.[28] British Society for Allergy and Clinical Immunology, *Guidelines for the Management of Allergic Contact Dermatitis*. [29] Ring et al., *Guidelines for Treatment of Atopic Eczema*, 1176-1193.[30] Bieber, *Atopic Dermatitis*, 1483-1494.[31] National Eczema Association, *Fragrance-Free vs. Unscented*.[32] Skin Health Alliance, *Understanding Fragrance Allergies in Skincare*.[33] British Association of Dermatologists, *Patch Testing for Contact Dermatitis*.[34] Environmental Working Group, *Volatile Organic Compounds in Household Products*.

Disclaimer: Although the author and publisher have made every effort to ensure that the information in this blog post was correct at press time, the author and publisher do not assume and hereby disclaim any liability to any party for any loss, damage, or disruption caused by errors or omissions, whether such errors or omissions result from negligence, accident, or any other cause. This blog post is not intended as a substitute for the medical advice of dermatologists or healthcare professionals. The reader should regularly consult a dermatologist or healthcare professional in matters relating to his/her general health, skin health and particularly with respect to any symptoms that may require diagnosis or medical attention.