Fragrance allergy is a chronic condition involving abnormal immune reactions to ordinarily harmless substances in fragranced products. This type of allergy generally causes symptoms on the skin that can be treated with medication. An allergist can confirm the diagnosis.
Up to 4.5 percent of the general adult population may be allergic to fragrance materials.
A fragrance allergy typically occurs when certain fragrance components called allergens come into contact with the skin. This causes the immune system to react by making protective proteins called antibodies to defend against the allergens. This inflammatory response leads to allergy symptoms.
In most cases, the reaction results in allergic contact dermatitis (ACD), an itchy rash that shows up on the skin that has been directly exposed to the irritating substance. The rash isn’t contagious, but it can be very uncomfortable.
Skin allergies to fragrance ingredients frequently involve the skin of the face, hands, or armpits.
Not every skin reaction is due to an allergy. Only an allergen can cause a true allergy.
In some cases exposure to certain substances can cause irritation, which does not provoke the immune system.
“Many people use the term ‘allergy’ for any type of reaction,” says Beth A. Miller, MD, director of the University of Kentucky’s Asthma, Allergy and Sinus Clinics and chief of the school’s division of allergy and immunology.
If you’re intolerant, as opposed to allergic, to a component of a fragrance, it will likely take much more of that component to elicit a reaction.
“Intolerance typically occurs in reaction to strong fragrances or [exposure to] large quantities, whereas an allergy can occur with just a trace amount,” says Tania Elliott, MD, an allergist and spokesperson for the American College of Allergy, Asthma & Immunology.
Symptoms of fragrance allergy generally affect the skin and include:
An itchy rash
Hyperpigmentation (patches of skin that are darker than usual), typically on people with darker skin
Swelling, burning, or tenderness
Bumps of blisters
“At times you can have weeping, blistering, poison ivy–like reactions,” says Purvi Parikh, MD, an allergist and immunologist at Allergy and Asthma Associates of Murray Hill and a clinical assistant professor at NYU Langone Health in New York City. “The more severe blistering can cause skin peeling and mimic burns.”
It’s also possible to develop respiratory symptoms. These can include:
Wheezing
Coughing
Chest tightness
Feeling of suffocation
Headache
Stuffy or runny nose
In rare cases a person can develop anaphylaxis, a severe allergic reaction that can be dangerous. These symptoms include:
Shortness of breath
Difficulty swallowing
Feeling lightheaded
Chest pain
A rapid or weak pulse
Nausea and vomiting
Allergic contact dermatitis can also lead to an infection if you repeatedly scratch the affected area, creating a place for bacteria to grow.
Allergy specialists or dermatologists can usually look at a rash on the skin and be able to diagnose if it is due to an allergic reaction compared to other factors.
If you have an unexplained rash, a physician may suspect a fragrance allergy after talking to you about your history of past outbreaks or discussing what personal care products you used before having a skin reaction.
In order to definitively understand what is causing the reaction and whether or not it is related to fragrance compounds, you will have to undergo skin patch testing. Patch testing is generally to see whether a substance is causing allergic skin inflammation (allergic contact dermatitis).
Patch testing does not involve needles. Instead, allergens are attached to patches that are placed on the skin of your arm or back. During the test, your skin is exposed to extracts of substances that can cause contact dermatitis. You wear the patches for 48 hours.
Skin responses are evaluated after 48 hours and again at between 72 and 96 hours for delayed hypersensitivity reactions, says John M. James, MD, a board-certified allergist and president of Food Allergy Consulting and Education Services in Fort Collins, Colorado, and a spokesperson for the Asthma and Allergy Foundation of America.
“If standard patch tests results are negative but there is a high clinical suspicion of a fragrance allergy, extended patch testing with a broader panel of individual allergens can be done,” says Dr. James.
Treatments for a fragrance allergy include:
Avoiding using products that contain the allergens
Prescription-strength steroids like hydrocortisone
You may want to call your doctor for an appointment if your rash:
Gets worse or keeps coming back
Lasts longer than three weeks
Affects your eyes or mouth
Impacts your ability to focus or sleep
There is nothing you can do to prevent developing a fragrance allergy, but there are simple steps you can take to avoid substances that will trigger a reaction if you want to live a fragrance-free lifestyle.
Always check the label before buying different cosmetic or personal care products like shampoo or body wash.
Avoid products with ingredients labeled “parfum,” “perfume,” or “fragrance”
Choose fragrance-free or hypoallergenic personal care products
Even if you know which allergens you are trying to avoid, it can still be difficult to eliminate the potential threat.
“Fragrance manufacturers aren’t mandated to list all the chemicals they use to make their perfumes on the product packaging,” says Susan P. Raschal, DO, a board-certified allergist at Family Allergy & Asthma in Tennessee. “This can make it difficult to identify the culprit for a reaction.”
Another obstacle in managing fragrance allergy is the fact that even if a personal care product is labeled “unscented” or “fragrance-free,” it may still contain fragrance components, sometimes called masking fragrances, which cover up offensive odors that may naturally occur in a product.
Another complication is that people can develop allergies over time. So a product that contains an allergen they weren’t allergic to could become a problem if they develop an allergy.
Once you develop an allergy to a fragrance allergen, it is likely a lifelong condition.
While you can’t control exposure to fragrance allergens in all environments, there are steps you can take to reduce your risk of having an allergic reaction, including:
Ask family and friends to refrain from wearing fragrances when you are around them
When traveling, look for hotels that can accommodate a fragrance-free and hypoallergenic request
Request that your room be cleaned with fragrance-free products before your stay
Request that linens and towels not be cleaned with scented detergent during your stay
Consider bringing your own towels and bedding when you travel
Request fragrance-free environments in public or work spaces
“Air purifiers with HEPA filters have been shown to be effective at reducing aerosolized chemicals and allergens,” says Raschal. She suggests using a portable, stationary, or wearable unit with HEPA filtration to reduce exposure.
Raschal also suggests that people who experience allergy or asthma exacerbations upon exposure to fragrances create an allergy action plan. This plan is a detailed document that outlines the steps to be taken in case a person experiences an allergic reaction.
Fragrance allergy is a chronic condition that generally affects the skin.
It’s difficult to avoid fragrance allergens because many products you use or regularly come into contact with contain substances that can trigger an allergy.
Treatment for allergic skin reactions include antihistamines and topical steroid creams.
