Fragrance Allergy & Sensitivity: Symptoms Prevention and Treatment - The Dermatology Review

Fragrance Allergy & Sensitivity: Symptoms Prevention and Treatment

Fragrance sensitivity. It sounds fairly innocuous, but for those who experience the symptoms, it can be debilitating, life-changing, even life-threatening. Fragrances both natural and synthetic are everywhere in the modern world and can cause a plethora of health problems.

Fragrance Sensitivity: An Overview

Fragrance sensitivity is when an individual experiences some level of irritation or an allergic reaction to ingredients, chemicals, or combinations of ingredients in products. 

Some of the symptoms of fragrance sensitivity are what you might expect such as nasal irritation, sneezing, contact dermatitis, and watery eyes. Other symptoms may be more surprising to those without much knowledge of this condition and include headaches, nausea, anxiety, and confusion. 

Something else surprising to those who are lucky enough to not be sensitive to fragrance is the prevalence of fragrances in modern life. Fragrances are not merely in overtly fragranced products such as perfumes and air-fresheners but are in many other less obvious places and products from hand sanitizer and toothpaste to magazines.  

There can also be extreme variations in the severity of symptoms associated with fragrance sensitivity. Some people may only experience mild irritation; red eyes, runny nose, or itchy skin for example. Others may suffer much more serious consequences from contact or inhalation of fragrances such as migraines, skin fissures, and allergy-induced asthma attacks.  

The consequences of having sensitivity to fragrance can also be numerous and severe. It can wreak havoc on people’s social lives and relationships. It can turn what should be everyday activities into anxiety-ridden and health-compromising situations such as accessing public transport, shopping and even being at work. 

Worryingly, the number of people who suffer from fragrance sensitivities is on the increase with some researchers describing this growing issue as an epidemic. Indeed, with some groups of people experiencing symptoms being as high as 1 in 3, it is something that, if it doesn’t affect us directly, will affect someone that we know. 

Causes of Fragrance Sensitivity

Although there are not known to be any definitive causes of Fragrance Sensitivity research shows that some groups of people are more likely to experience fragrance sensitivity or fragrance allergies. These groups are:

  • People with autism
  • Asthma sufferers
  • People who have been exposed to high levels of chemicals in the past (such as forces veterans who experienced chemical attacks)
  • Those with eczema
  • Sufferers of chronic respiratory diseases

There is also research that demonstrates a link between those who suffer from contact dermatitis caused by perfume allergies and sensitivities and respiratory symptoms. This suggests that if someone suffers from one form of sensitivity they are more likely to suffer the other as well. 

Chemicals or combinations of chemicals are often the main culprits of the symptoms associated with fragrance sensitivity (although, sometimes natural fragrance can causes irritations as well, usually in the cases of allergies). Research has shown a lot of crossover between Multiple Chemical Sensitivity (MCS) and Fragrance Sensitivities. This is unsurprising when studies into the ingredients which make up fragrances and fragranced products have shown that in a sample of 31 products there were around 150 different Volatile Organic Compounds (VOCs). VOCs have been linked to many health problems that match the symptoms experienced by people with Fragrance Sensitivities. The same study found ‘Hazardous Air Pollutants’ as classified by the US Environmental Protection Agency (EPA) in 5 out of 6 fragranced laundry products and air-fresheners. Chemicals that are considered to be Hazardous Air Pollutants by the EPA are those that are known to cause cancer and other serious health problems. 

Symptoms of Fragrance Sensitivity

Fragrance sensitivity often causes symptoms within two main categories; respiratory symptoms and skin reactions. However, it can also manifest in a staggering number of different ways and can range from being relatively mild to severe and in some cases life-threatening allergic reactions. Symptoms include, but are not limited to the following:

Symptoms related to skin

    • Contact dermatitis
    • Swelling
    • Painful skin fissures
    • Skin Vesicles (small fluid-filled sacs, like blisters)
    • Scaling
    • Hives
    • Rashes
    • Erythema or redness of the skin
    • Itching

Respiratory Symptoms

    • Congestion
    • Chest Tightness
    • Rhinitis
    • Sneezing
    • Coughing
    • Fainting
    • Airway irritation
    • Wheezing
    • Breathlessness
    • Breathing difficulties

Other Symptoms

    • Headaches 
    • Anaphylaxis
    • Migraines
    • Anxiety
    • Panic Attacks
    • Reduced pulmonary function
    • Diarrhea and vomiting in small children  
    • Difficulty concentrating
    • Confusion
    • Irritation of sensory organs
    • Watering Eyes
    • Itchy Eyes
    • Red Eyes
    • Nausea

How to Prevent Fragrance Sensitivity

The only way to prevent the symptoms of fragrance sensitivity is avoidance. This, however, can be more difficult than people who have never experienced the condition might think. Those with Fragrance Sensitivities can be at risk of either intentional or unintentional exposure. The sheer number of fragrances and chemicals that feature in everyday life make total avoidance virtually impossible. You can be walking down the street but someone’s tumble drier vent is sending out air contaminated with fragranced laundry product or someone walks past you wearing a lot of strong perfume. Sometimes too, people with this sort of sensitivity or allergy find themselves having to make difficult choices that can impact their health in different ways. Think about sunscreen, it is vital in protecting ourselves against dangerous UVA and UVB rays, but what if wearing it or putting it on your children makes you feel unwell or makes breathing difficult. What about toothpaste? Oral hygiene impacts your general health and wellbeing but if the fragrances in toothpaste make you ill you are left in a difficult position. 

Intentional Exposure
Intentional exposure is easier to avoid as suffers can use un-fragranced products on their hair and body such as un-fragranced soaps, moisturizers, and shampoos. This does limit quite severely the variety, and some would argue, the quality of products available but that is a small price to pay for your health and wellbeing. However, the price itself is another aspect to consider with products that are safe for people with fragrance sensitivities as they often have a higher price tag than their heavily fragranced counterparts.  There can be difficulties in finding un-fragranced health and beauty products in the first place. Firstly because there simply aren’t as many products un-fragranced products available as those with fragrance. But this is also in part this is due to incomplete disclosure on ingredients lists. Currently, laws surrounding ingredients on these sorts of products do not have to break down what ingredients make up the fragrance; instead, you are likely to see simply ‘parfum’ or ‘fragrance’. This is sometimes because of trade-secrets surrounding product ingredients but it certainly makes trying to avoid fragrance more difficult. There can also be some confusion about whether a product is suitable for fragrance sensitive people if the label reads ‘un-fragranced’ or whether it reads ‘unscented’. Currently, if a product is called ‘unscented’ it can mean that it contains masking chemicals. Simply put, it still contains the ingredients which may trigger symptoms in fragrance sensitive people, in fact, it may contain even more of them! 

 When it comes to your own home those who are fragrance sensitive can have more control over limiting and completely avoiding fragranced products. Rather than using air freshening products, opening windows and circulating air helps keep your home smelling pleasant and is healthier for you too. When it comes to cleaning and laundry products there are some un-fragranced products available – but some people find it easier, to make their own using natural or unadulterated cleaners such as bicarbonate of soda, vinegar, citric acid, and/or soda crystals. When decorating your home there are some household paints such as chalk-based paints too that although may not be completely fragrance-free may not put such a strain on fragrance sensitives than more traditional house paint.  

Unintentional Exposure
Studies that have focused on qualitative data that is, looking at the subject in depth but with a smaller amount of people show that fragrance sensitivities can force people into making vast changes to their lifestyles. For many it means avoiding or putting strains on relationships with family and friends, affecting work sometimes preventing people from being able to work at all.  Often as well as changing their lifestyles and habits and being constantly vigilant and aware of potential triggers sufferers experience much anxiety over unintentional exposures and confrontations resulting from needing to speak up for their health and wellbeing. When you stop and think about all the encounters we have with fragrance on a daily basis it becomes clear what a truly disabling condition it can be. From having to avoid people wearing traditional fragrances such as perfume, aftershave or cologne, or body sprays. To avoiding those who have used even more commonly used products such as deodorants, moisturizers, hairsprays, hand lotions, makeup, freshly painted nails, clothes washed in laundry detergents, or even people who have been in close contact with people who have. And that’s just the beginning. People with these sensitivities risk bombardment from fragrance in shops, in other people’s houses, on public transport, in taxis, and public restrooms, even freshly printed magazines can be a trigger for people with high levels of sensitivity. 

Fragrance Sensitivity: An Employees Guide

The first thing to remember if you have fragrance sensitivity is that everyone has a right to work in a healthy and safe environment. 

In the US, Fragrance sensitivity can be recognized as a disability under the Disability Discrimination Act (DDA). In the UK, Health and Safety legislation require employers to safeguard the health and safety of employees ‘as far as is reasonably practicable’. 

If a fragrance sensitivity is impacting upon your ability to go to work or your ability to work effectively then your first step would be to speak to your employer about it. If it would be helpful to do so you should also talk to your colleagues. 

It can help your employers and colleagues to help you if you can be solutions focused and have some suggestions prepared to help get proceedings moving in a positive way. 

It is important to recognize that there may be substantial difficulties in making your workplace completely fragrance free – consider the difficulties you face in ensuring your own home is free of triggers. Instead aim to limit exposure as far as reasonably practicable. 

Things that can be considered in this regard include:

    • Desk or workspace positioning
    • Access to fresh air – being close to a window
    • Removal of any air-fresheners such as plugins 
    • Removal and/or replacement of soaps, air-fresheners in communal spaces such as bathrooms
    • Removal and/or replacement of cleaning products
    • Communications with co-workers or colleagues to ensure awareness such as informative (rather than directive) memos and gentle reminders to be cognizant and courteous of others
    • Possibilities to join in meetings or other high-risk situations via an online platform such as Skype or Zoom. 

How to Help Someone You Know With a Fragrance Sensitivity

The statistics suggest that are if you do not experience irritation or allergic reactions to fragrances in products then someone you know will. 

Hopefully, from reading this article you will now have a greater understanding of the difficulties posed by Fragrance Sensitivity and therefore be more mindful and considerate of those that suffer from it. 

Some tips for helping those you know who have a Fragrance Sensitivity include:

    • Speak up. Ask questions. Let the Fragrance sensitive person know that you understand and are keen to help them limit their exposure to things that make them feel unwell – this in itself will help ease their anxiety levels – a common problem facing people with fragrance sensitivities.
    • Be mindful of the products you buy and use particularly if you know you are going to see someone you know has a fragrance sensitivity or if they are coming to see you.

5 Tips for Buying Fragrance-Free Products

  1. Always read the label – beware of not only ingredients such as perfume, perfume, and fragrance but of products that claim to be unscented. 
  2. Look for the ‘Safer Choice’ label. This is the U.S. Environmental Protection Agency’s (or EPA’s) marker which helps people identify products that have natural ingredients or safer chemical ones. Products without chemical scents and therefore should be safer for people with fragrance sensitivities, are marked as such in the top left-hand corner of the label. 
  3. Visit the MADESAFE website. Non-profit organization MADESAFEs aim is to make it as easy as possible for people to avoid toxic chemicals for a variety of environmental and health reasons. The MADESAFE list of certified fragrance-free products is subdivided into different categories such as baby and child, household cleaning, feminine care, cosmetics, laundry products, personal care, and sexual health. 
  4. Download The Environmental Working Group’s Skin Deep app which provides ratings for over 78,000 beauty products and nearly 11,500 ingredients. Simply scan the bar code of the product before you buy to find out detailed information that can help you avoid fragrances

Treatments For Fragrance Sensitivity

The best treatment by far for fragrance sensitivity is avoidance. However, as outlined in How To Prevent Fragrance Sensitivity this is not always possible. Some symptoms of fragrance sensitivity can be treated with allergy medications; antihistamines or steroid-based medications. 

Skin Treatments

    • If you have come into direct contact with a fragrance or fragranced product wash the area immediately and thoroughly with warm water and an un-fragranced soap if possible. 
    • Some people with sensitive or eczema-prone skin find that taking a colloidal oatmeal bath helps reduce skin irritation. If you are unable to find colloidal oatmeal, using regular oats tied up in a stocking and placed in your bath with work as well. Oats have anti-inflammatory properties that can help relieve itching and calm redness. Oatmeal is also an emollient which means it creates a protective barrier over your skin. Always do a patch test first. 
    • Bathing in baking soda (also called bicarbonate soda) can also help to relieve the skin reactions associated with fragrance sensitivity. Simply add ¼ to 2 cups of baking soda to a warm bath. Always do a patch test first. 
    • A topical hydrocortisone based cream (a mild corticosteroid) may help to relieve symptoms such as rashes, dermatitis, itching, swelling, and redness. These creams are usually available to buy over the counter but you should consult with a pharmacist or doctor to find one that is suitable. 
    • Some people may find that applying calamine lotion, an anti-inflammatory may help relieve itching

Treatments for Respiratory and other Symptoms

    • Get some fresh air as quickly as possible.
    • For those with asthma, there is some evidence that shows that fragrance sensitivities decrease as asthma is better managed with medications such as steroid inhalers.
    • Doctors can also prescribe inhalable steroid and cortisol based medications.  For those who suffer the most severe form of allergies, anaphylaxis, Epinephrine should be administered as quickly as possible – these medications often known as Epi-pens can only be prescribed by doctors.
    • Headaches and sometimes migraines can be relieved with paracetamol or ibuprofen but only as an irregular and short term solution.
    • Anti- migraine medication has to be prescribed by a doctor. These are usually Triptans – which work by narrowing blood vessels in the brain.
    • Over the counter allergy medications like oral anti-histamine or cold medication containing decongestants can relieve the symptoms such as nasal congestion, sneezing and coughing.

    How Common is Fragrance Sensitivity?

    Studies have shown that up to 30% of the general population is either irritated by or suffers adverse reactions to fragrances. For those with asthma, the figure jumps up by a further 7%. For those who either self-identify as having, or have been medically diagnosed with, Chemical Sensitivity or Multiple Chemical Sensitivity there is a further increase of between 20% and 30% to over 67%. Moreover, research indicates that this is on the increase. 

    These figures indicate that there may be a lot of people out there suffering in silence about the effects that fragrances are having on their health. Perhaps it is time that awareness of this problem increases to help safeguard the health of the 1 in 3 people who suffer from Fragrance Sensitivities.

    References:
    A link between skin and airways regarding sensitivity to fragrance products? – Elberling – 2004 – British Journal of Dermatology – Wiley Online Library  BJD British Journal of Dermatology, Volume 151, Issue 6, December 2004 Pages 1197-1203.
    Caress, Stanley M., and Anne C. Steinemann. “Prevalence of Fragrance Sensitivity in the American Population.” Journal of Environmental Health, vol. 71, no. 7, 2009, pp. 46–50. JSTOR, www.jstor.org/stable/26327879. Accessed 12 Jan. 2021

    Causing a stink: The truth about fragrances and your health | New Scientist
    EWG | Environmental Working Group
    Fragrance Sensitivities Can Actually Be Very Severe, Study Finds | Health.com
    Hazardous Air Pollutants | US EPA
    Health and safety legislation – laws in the workplace (hse.gov.uk)
    Implementing a Workplace Fragrance Policy as an Accommodation (askjan.org)
    MADE SAFE Certified Fragrance-Free Products
    Raising Fragrance Sensitivity Awareness in the Workplace (odorklenzlaundry.com)
    Shopping For Cosmetics? Take EWG’s Skin Deep App | EWG
    Steinemann, A. International prevalence of fragrance sensitivity. Air Qual Atmos Health 12, 891–897 (2019).
    What are volatile organic compounds (VOCs)? | Indoor Air Quality (IAQ) | US EPA

    When perfume causes a stink in the office | Business | The Guardian
    Why do fragrances cause health problems for one in three people? | New Scientist

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