Fragrance and Health

The Human Ecologist has published a series of articles beginning with “Focus on Fragrance and Health”, in 1992-1993, and then again in Summer of 1998.  The Human Ecologist kicks off a new series, Focus on Fragrance and Health Update. It contains new information about why fragrance is harmful, and how many people are adversely affected by fragrance. There are good reasons why the allergic, asthmatic, and chemically sensitive find fragrance problematic. And the numbers of such people are growing.

Since then, the magazine has provided on-going coverage of the issue. But fragrance exposure continues to be a serious problem for the allergic, asthmatic and sensitive: Fragrance topped the list of troublesome exposures reported in HEAL's recent member survey.

Fragrance use by family members, co-workers, service providers, and people in public places constitutes a significant problem for people whose health is adversely affected by fragrance exposure. Yet fragrance users as a group tend to resist the notion that their behavior may have negative impacts on others. As part of the new series, The Human Ecologist offers a 'dialogue' with a fragrance user -- an exchange of ideas and opinions on both sides of this difficult and contentious issue.

The Human Ecologist broke new ground in its original series on fragrance and health, by providing facts about what fragrance materials contain, and the health effects of those materials; facts about how many people are affected by adverse effects of fragrance exposure; facts about federal regulation (and lack thereof) of fragrances and scented materials. The new series continues in this groundbreaking tradition. We think it is "must reading" for all concerned about fragrance and health -- regardless of which side is taken.

Understanding fragrance and health -- 5 myths.
                                                                                                                                                                                                                                     by Louise Kosta
                                                                                          Chief writer, The Human Ecologist

In 1989, "Dear Abby" published a letter from HEAL about health effects arising from exposure to fragrance. Immediately, HEAL's office was inundated with thousands of requests for information about fragrance and health. At that time, people who were sensitive to fragrance experienced great difficulty in obtaining fragrance free home and personal care products, and suffered health effects as a result of using scented products. Products labeled "unscented" or "hypoallergenic" that actually contained fragrance materials were particularly problematical then (as now). HEAL was the only source in the U.S. that was capable of providing factual information to fragrance sensitive people about fragrances in consumer products, and about sources for unscented equivalents. The organization received many appreciative comments from people who contacted the organization as a result of the "Dear Abby" letter.

In the decade since that letter appeared, HEAL has continued to receive a steady stream of calls and letters about the problems fragrance poses to those who are sensitive to it. Over time, it has become somewhat easier for fragrance sensitive people to find truly fragrance-free products they can use themselves. This has substantially improved their well-being. However, they continue to be troubled by the fragrances used by others, both for personal care and for household and building maintenance. For fragrance sensitive people, such exposures have significant health impacts, and far-reaching consequences in other areas of life.

Sustained member and public interest has prompted HEAL to set a high priority on publishing information on fragrance and health. In 1992 - 93, The Human Ecologist published its first series of articles about this issue. It was an immediate hit with HEAL members, who used it to inform their family, friends, co-workers and health care providers about fragrance sensitivity. In 1998, the magazine published another series of articles on fragrance and health, reflecting new information that had become available in the intervening years. It too received favorable comments from HEAL members, as well as interest from the press. HEAL announced publication of a book, Fragrance and Health, in late 1998. (1)

Those who are affected by fragrance sensitivity have serious health problems when they encounter fragrances. However, people who use fragrance, or who select scented products for use in settings where fragrance sensitive people may (or must) be present, express considerable resistance to the idea that fragrance sensitivity is a serious problem.

Thus the publication in 1998 of Fragrances: Beneficial and Adverse Effects (2) is a welcome development. This book, the proceedings of a 1996 symposium on fragrances held jointly by the American Contact Dermatitis Society and the European Society of Contact Dermatitis, confirms many facts about "the fragrance problem" that have met with derision from those who believe that fragrance exposure can't be a problem -- or if it is, it's a minor problem that affects only a few people.

Expert opinions on fragrance and health - from medicine, research, industry and government

The 1996 fragrance symposium was held "independent of any drug or cosmetic promotion" and was "motivated by the need for informed debate on an important medical and environmental issue without the bias that sponsorship brings," according to the president of the European Society of Contact Dermatitis in the Foreword to Fragrances: Beneficial and Adverse Effects. Participants in the symposium, and contributors to the proceedings, include physicians and researchers from U.S. and European medical schools, private and multinational industry facilities, and government research centers.

Although the title suggests parity between benefits and risks of fragrances, Fragrances: Beneficial and Adverse Effects does not give equal time to the two topics. Benefits of fragrances are discussed in four papers (two of which concern insect behavior), for a total of 25 pages out of a total of 232 pages. Adverse effects (12 papers), testing procedures and their limitations (5 papers) and industry approaches to fragrance material safety (4 papers) comprise the bulk of the book.

Given the nature of the forum in which the symposium was held, the primary focus of the proceedings is on the effects of skin contact with fragrances, and thus with adverse effects of fragrance materials primarily (but not exclusively) on fragrance users. However, a detailed examination of the text offers very interesting insights into what the best informed researchers know about fragrance materials in general, and how they obtained that knowledge. In a nutshell, the best informed researchers don't know enough about fragrance materials to either predict how they will behave in use, or to anticipate who is likely to experience adverse effects from their ordinary use. What they do know they learned from testing procedures that appear to be inadequate. In effect, Fragrances: Beneficial and Adverse Effects lays to rest some persistent myths about fragrance and health. Five such myths are discussed below.

Myth 1. Few people are adversely affected by fragrance. Fact: "Adverse reactions to fragrances/fragranced cosmetics appear to be far from rare."

Allergic reactions to fragrance materials are common, according to A.C. deGroot and P.J. Frosch (3). In 1987 deGroot surveyed over 1600 adults, and 12% reported reactions to cosmetics and toiletries; 35% of the reactors and 4.3% of the total sample attributed these reactions to products used for their smell (deodorants, aftershaves, and perfumes).(4) In a 1980 study of adult women, 32% reported histories of adverse reactions, and 80% of those with a positive history of sensitivity also had positive skin tests for fragrance material allergy.(5)

Despite the focus on skin conditions caused by fragrance exposure, deGroot and Frosch also note the following: "Fragrances can induce or worsen respiratory problems," citing a study published in the medical journal Chest (6), and adding, "Persons with respiratory allergy commonly experience aggravation [of their symptoms] around cosmetic counters, candle shops, and perfume worn by other people, for example, in church. This is thought to be due to a direct release of histamine . . . ." (7) An estimated 20% of the general population has allergies. That is, one in five people may be at risk for adverse effects from fragrance exposures from all sources.

Myth 2. It is easy to avoid fragrances- just don't use them. Fact: Fragrances are ubiquitous.

"Fragrance...[is] found in a large number of manufactured products, but the main source of exposure is...perfumes and cosmetics. It is estimated that 95% of the female population, and at least 75% of the male population, come into daily contact with [such] products, and it is therefore not surprising that perfumes represent a major source of sensitization," according to J.P.Lepoittevin and V. Mutterer, in "Molecular aspects of Fragrance Sensitization." (8) Frosch and deGroot offer the following in evidence of the ubiquity of fragrances: "virtually all cosmetics and toiletries contain fragrance materials, even 'unscented' or 'fragrance free products .... Flavors used in oral hygiene products- toothpaste, mouthwash, and dental floss- are fragrance chemicals. Scented household products include detergents, cleaners, softeners, deodorizing sprays, polishes, solvents, and waxes. In industry, cutting fluids, electroplating fluids, paints, rubber, plastics, insecticides, herbicides and additives used in air conditioning water may all be scented. Eugenol is widely used by dentists. Paper and paper products- including diapers, facial tissues, moist toilet paper and sanitary napkins- may cause a reaction. Fabrics and clothes may contain fragrance materials, especially after they are laundered or treated with a fabric softener. Topical drugs often contain perfumes, and ventilating systems may spread fragrances."(9)

For sensitive people, just avoiding fragrance use is not enough to protect health. Any contact with fragrance can provoke a reaction. Such contacts include (besides direct contact with skin or mucous membranes) "contact with a. . . contaminated product such as towels and pillows, contact with products used by partners, friends or coworkers ('consort' or 'connubial' contact dermatitis [for example]), airborne contact, and systemic exposure by inhalation and ingestion (fragrances, flavors and spices in foods and drinks, cough syrup [etc.])." (10)

Myth 3: Fragrances are regulated by the government and therefore safe. Fact: "The figures on adverse effects reported. . . worldwide suggest that the safety procedures employed so far are not sufficient."

"Legislation is still very 'generous' about fragrances . . . . It can no longer be tolerated that some manufacturers sell their perfume as an artful creation but as a 'black box' regarding the constituents and safety data." (12) The role of U.S. regulation in fragrance manufacture and distribution is discussed at length in Fragrance and Health (13). In summary, fragrance product manufacturers do not have to clear fragrance materials with the Food and Drug Administration before using and selling them. Fragrance formulas are considered proprietary, and are therefore covered by trade secret rules. This makes it impossible for consumers to know what specifically is in any scented product. Although fragrance accounts for most of the adverse effect reports FDA receives on cosmetics, it is impossible for either consumers or FDA to know what constituent(s) in fragrances are responsible for the reported adverse effects. Without this knowledge, FDA is unable to act to prevent such effects from occurring.

Note that fragrances are complex: "A single perfume contains from 10 to 300 different [fragrance] molecules." This complexity makes identification of 'bad actors' in fragrances extremely difficult. "The presence . . . of several [types of] molecules which differ widely in size and reactivity can result in many interactions during skin penetration, biodistribution . . . metabolism or interaction with antigen presenting cells." "The presence of dozens, or even hundreds, of different molecules makes all types of interaction between molecules possible . . . . "(14)

Myth 4: Synthetic chemical fragrances are the culprits in fragrance sensitivity-natural fragrance materials are safe. Fact: The biological activity, not the source, of fragrance materials, is the cause of adverse effects.

Natural d-limonene, a common fragrance ingredient usually derived from citrus peel, readily breaks down into sensitizing strong allergens. (15) A chemical analysis of 22 'natural based' cosmetics products revealed that these products contained many allergens. (16) This confirms information in Fragrance and Health regarding the widespread distribution of allergens and sensitizers in natural fragrance materials. It is worth noting that Fragrance: Beneficial and Adverse Effects concentrates its attention primarily on the allergenicity of fragrance materials, whereas Fragrance and Health is also concerned with irritancy of these substances. The topic of irritancy is an important one for those affected by airborne inhalant fragrance exposure: The tissue changes that occur in the upper and lower respiratory tracts of people with allergy and asthma make them particularly susceptible to adverse effects from airborne irritants, including those found in both natural and synthetic fragrance materials. (17)

As for safety testing of fragrance materials, the authors who discuss this topic in Fragrance: Beneficial and Adverse Effects generally fail to discuss, and thus actually bring into sharp focus, the fact that fragrance materials are typically tested one at a time, even though they are generally used in combination in fragrance products. Nevertheless, serious questions about the efficacy of commonly used testing procedures are raised, including the difficulty of extrapolating the results of animal tests to human health effects (or lack thereof). The complexity of fragrance products, and the potential for interactions among different fragrance materials, contained in the same product, adds considerable uncertainty to the results of testing procedures as currently employed. (18)

Myth 5: Fragrance materials applied to the skin stay on the skin. Fact: "All chemicals, including fragrance ingredients, can be absorbed into the body to some degree. The principal route for absorption of fragrance ingredients is the skin."

This statement (18) is further explicated as follows: "Historically, the skin has been regarded as an inert structure which acts as a relatively impervious barrier to the inward movement of chemicals. However, it is now accepted that the skin is not a complete barrier, but is, in fact, an important route of entry of xenobiotics into the systemic circulation. . . .The fragrance chemical and/or its metabolites may be absorbed . . . and distributed to distant sites of the body."(19)

The absorption of synthetic musk fragrance ingredients is a case in point. These compounds are widely distributed in many consumer products, including cosmetics, soaps, laundry products, fabric softeners, household cleaning products air fresheners, and so on. Worldwide synthetic musk production in 1987 was estimated at 2500 tons. Human exposure to these compounds is thought to be widespread. Scientists have examined concentrations of synthetic musk compounds in human blood, milk, and fatty tissue. "These synthetic musk fragrances represent a new group of ubiquitously distributed contaminants in human fat and milk, comparable with the contamination by. . . certain pesticides, PCBs and dioxins." It is believed that most of this contamination occurs through the skin, from deliberate use of synthetic musk fragrance products, or from prolonged contact with fabrics laundered with musk-scented cleaning and conditioning products. Once absorbed by the body, one synthetic musk compound studied (musk xylene) has a half-life of 100 days; this means that a single absorbed dose of musk xylene takes months to be eliminated from the body. (20)

[Maternal absorption of synthetic musk compounds could result in infant exposures to these compounds in mother's milk. The infant may thus be exposed via contact with fragrance on the mother's skin, and with clothing and bed linens laundered in musk-scented laundry products, by breathing emissions from musk scented cleaning and air freshening products, as well as by ingesting contaminated breast milk. This continuous exposure of infants to synthetic musk may be inadvisable.]

"There is very limited knowledge about the chronic toxicity of these artificial fragrances. . . . Little has been reported about their toxic and possibly other adverse biological effects . . . . [but] due to their high bioaccumulation potential in humans . . . their general persistence, lipophilicity, dermal permeability, and insufficiently assessed toxicity, these synthetic musk fragrances should be immediately replaced in cosmetics and detergents by other compounds which are toxicologically and ecologically harmless." (21)

Note that any consumer concerned about avoiding exposure to these compounds can only do so by avoiding exposure to all scented products. The widespread distribution of these fragrance materials, and the lack of product labeling, make any other course of action ineffective.

Conclusion

The editors of Fragrance: Beneficial and Adverse Effects state in their introduction, "Although not all [adverse] reactions [to fragrance materials] are clinically meaningful, adverse reactions to scented materials are by no means rare. They often cause considerable discomfort, require medical attention, and are a burden for the highly sensitized patient."

Noting deficiencies in the regulation of fragrance materials for safety, the editors suggest that, even when concern about adverse effects of fragrance is limited to contact dermatitis, the industry has failed to protect consumers from fragrance induced harm. They also suggest that the industry is either unwilling to regulate itself, or is incapable of doing so. And they suggest that, heretofore, fragrances have not received sufficient attention from a variety of disciplines that could contribute to the understanding of fragrance related harm, and work toward prevention: "Some [manufacturers] do not even respect the recommendations of their own industry [with regard to safety] .... A close surveillance system with full cooperation of manufacturers, dermatologists, pharmacologists, toxicologists, epidemiologists and consumer agencies is overdue."

Fragrances: Beneficial and Adverse Effects offers valuable insight into the weaknesses of standard toxicity testing methods when dealing with complex substances like fragrance materials. Inadvertently, it illustrates the severe conceptual difficulties imposed by attempts to study adverse effects of fragrance materials by confining concern to a single set of problems (contact dermatitis) experienced by only some of the people who are exposed to the test substance. It is quite clear, however, both from this book and from other sources, that adverse effects of fragrance exposure are not confined to skin effects. Nevertheless, even when concern is limited to dermatitis, there is plenty of cause for concern about adverse effects from fragrance.

Even though Fragrances: Beneficial and Adverse Effects does not provide the "smoking gun" so eagerly sought by anti-fragrance advocates, skeptics should find it compelling, especially with regard to the conclusion that safety and health concerns are not being met by the fragrance industry's current regulatory framework (or lack thereof). It has indisputable credibility, because the authors have respectable credentials and are writing about well-recognized phenomena with strong ties to 'mainstream' medicine. Best of all, the authors discuss the lack of toxicity information at their disposal, the lack of reliable test methods and data, the lack of an effective regulatory system to protect health, and the lack of information about health effects that may have great relevance to the overall picture of health effects from fragrance.

Lest anyone still be inclined to shrug off adverse effects from fragrance as being of minor importance, affecting few people, and having only transient, nuisance effects, consider the following: "Contact dermatitis from the application of spray cologne . . . . to a female patient resulted in the development of erythema multiforme with progression to toxic epidermal necrolysis and ultimately her death."

Notes:

• (1) L. Kosta, Fragrance and Health. Atlanta GA: Human Ecology Action League, Inc. 1999. In press.
• (2)P. J. Frosch, J. D. Johansen and I. R. White, editors. Fragrances: Beneficial and Adverse Effects. Berlin, Heidelberg, New York: Springer-Verlag, 1998.
• (3) A.C. deGroot, P.J. Frosch, Fragrances as a cause of contact dermatitis in cosmetics. In (2).
• (4)A.C. de Groot et al., Adverse effects of cosmetics: a retrospective study in the general population. Int.J.Cosmet Sci 9: 255-259, 1987. In (3)
• (5) J.D. Guin and V.K. Berry. Perfume sensitivity in adult females. J. Am Acad Dermatol 3:299-302, 1980. In (3).
• (6) D.P. Schleuter, Airway response to hair spray in normal subjects and subjects with hyperactive airways. Chest 75:544-547, 1978. In (3).
• (7) In (3).
• (8) J.P. Lepoittevin and V. Mutterer, Molecular aspects of fragrance sensitization. In (2).
• (9) In (3).
• (10) In (3).
• (11) P.J. Frosch, J.D. Johansen, I. White, Preface. In (2).
• (12) In (11).
• (13) In (1).
• (14) In (8).
• (15) A.-T. Karlberg, d-Limonene- an old perfume ingredient introduced as a 'natural' solvent in industry: is there a risk of sensitization? In (2).
• (16) S.C. Rastogi. Contents of sensitizing fragrance materials in natural ingredient based cosmetics. In (2).
• (17) In (1).
• (18) W.G. Larsen, How do we test for fragrance allergy? P.J. Frosch, Are major components of fragrances a problem? J.D.Johansen, Quantitative aspects in patch testing and usage tests..M.M Kligman, Reappraisal of the guinea pig maximization test. R.R. Suskind, The hydoxycitronellal story: what we can learn from it. B. Basketter, The value of animal assays and the quenching phenomenon. W.W.Lovell, In vitro photoxicity tests for fragrances. R.A.Ford, RIFM activities in the safety assessment of the dermal effects of fragrance materials. All in (2).
• (19) E.A. Pfitzer, RIFM Activities in the safety assessment of systemic effects of fragrance materials. In (2).
• (20) S.A.M. Hotchkiss, Absorption of fragrance ingredients using in vitro models with human skin. In (2).
• (21) In 19.
• (22) G.G.Rimkus, Synthetic musk fragrances in human fat and their potential uptake by dermal resorption. In (2).
• (23) J.A. Thompson Jr. et al., A case of contact dermatitis, erythema multiforme, and toxic epidermal necolysis. J Am Acad Dermatol 5: 666-669, 1981.In (3).

Notes and Comment:
HEAL members speak out about fragrance

The overwhelming majority of HEAL members report having health conditions that require exposure avoidance as part of symptom management. In September 1997, The Human Ecologist published a member survey fill-in-the-blank questionnaire, to gauge member perceptions of their health-related concerns. Responses began to come back almost by return mail, and are still arriving in the HEAL office. A significant percentage of all respondents reported difficulties with exposures to fragrances used by others. Here are some verbatim samples of how HEAL members filled in the blank in the following sentence:

My most troublesome exposure is...

• ...fragrance in all forms.
• ...fragrance on people, and in dryer exhaust.
• ...neighbors' fragranced dryer exhaust in my yard.
• ...perfume and hairspray on co-workers.
• ...perfume, aftershave, cologne in the hospital (my workplace), and in stores.
• ...perfume, because it keeps me from church and social gatherings, and from building a support system.
• ...perfume in church and restaurants.
• ...perfume in dryer exhaust in my yard.
• ...perfume, especially in public buildings and on people.
• ...perfume everywhere.
• ...fragrances, because everyone has fragrance of some sort on in public.
• ...fragrances everywhere (now that smoke-free environment is closer to reality).
• ...perfume- it's ubiquitous.
• ...perfume in public places.
• ...perfume in public places.
• ...perfume in public places.

 HEAL Public Information Committee

 What do the following people have in common?

• People with allergies (50 millions in the US) 1 
• People with asthma (15 million in the US) 1  
• People with chronic severe headaches (45 million in the US) 2   
• People with sensitivities (10 to 30 million in the US) 3

                                                                                   Perfume can make us sick.

1. American Association for Allergy, Asthma an d Immunology, 1999
2. National Headache Foundation, 1999
3. Department of Health Services, California, 1996

FRAGRANCE AND HEALTH by Louise Kosta, published by the Human Ecology Action League, Inc. (HEAL®), that explores what is known about fragrance and health – and separates fact from fiction.  Learn who is susceptible to these adverse effects, why they are susceptible, where they experience harmful fragrance exposures, and what harmful properties fragrance material may have.  Almost 200 pages packed with information about fragrance, its materials and their health effects, tables, references and much, much more.

• What price fragrance materials?  … Big bucks!
• User’s scorecard:  accidental fragrance use  … Users see how much fragrance they’re really using.
• Talking about health effects … Clear, concise and accurate discussion of allergy, asthma, MCS, and fragrance.
• User’s scorecard:  signature fragrance … Users learn that it’s more than just a “dab here and there.”
• Aromatherapy – Fragrance for health?  … Alternative treatment is not for everyone
• What’s in a spritz?  … Real fragrance products, real toxic effects. 
• Fragrance ingredients that don’t smell … Are they inert, or do they contribute to harmful effects?
• Fragrance in the workplace  … Avoid employee disputes, customer and client loss.
• Scented cleaning products:  a federal perspective  … Should the federal government clean its 7,700 buildings with scented products?
• “Aromachology” – led by the nose? …The fragrance industry claims that fragrance can affect behavior.  Who benefits?

An important resource for the fragrance-sensitive person, especially those with MCS.
                                                                                                       Iris R. Bell, M.D., Ph.D.

“Fragrance and Health” is a publication of the Human Ecology Action League, Inc. (HEAL®), which has provided education and information about environment and health since 1977.  All proceeds from the sale of “Fragrance and Health” benefit HEAL.

To order Fragrance and Health, by Louise Kosta.(Paperback, 9 sections, 30+ articles, references, tables.) US funds only. Members: US $12.50, Canada $15.50, other countries $20.50. Non-members: US $25, Canada $31, other countries $41. By mail, send check, money order or credit card information (VISA, MC, AMEX account number and expiration date) to HEAL, P.O. 509, Stockbridge, GA  30281. Credit card orders accepted by phone: (770) 389-4519. Because of the substantial member discount, those interested in obtaining Fragrance and Health may also like to consider joining HEAL.