Fragrance Allergy

Fragrance allergy is a delayed (type IV) contact allergy to perfume ingredients, and one form of Allergic Contact Dermatitis. It is one of the most common contact allergies in children. Patch Testing screens for it with fragrance mix I, fragrance mix II and balsam of Peru, although “fragrance” covers hundreds of separate chemicals (Tam & Yu 2022). Children are exposed through personal-care products, detergents and perfume, and also “by proxy” from a parent’s or sibling’s scented skin and clothes. Fragrance in patch-tested skin switches on TH2-type genes, the same immune pathway that drives Atopic Dermatitis (Tam & Yu 2022).

Fragrance Allergy [part-of] Allergic Contact Dermatitis Patch Testing [defines] Fragrance Allergy Fragrance Allergy [worsens] Atopic Dermatitis

Positivity in children with AD. In an Italian multicentre series of 432 children aged 0–14, fragrance mix II was positive in 3.2% and fragrance mix I in 2.1%. Both mixes were positive more often in children with AD than in children without it. Children with AD had more positive patch tests overall (36.9% vs 26.4%), and 22.0% of the 0–<3-year group had at least one positive result (Bonamonte 2022). The mixes do not catch everything. Over half of children who react to hydroperoxides of linalool or limonene (oxidised terpenes found in about 90% of Essential Oils) test negative to fragrance mix I/II and balsam of Peru, so these hydroperoxides need testing separately. They were tested in under half of paediatric cases (Tam & Yu 2022).

Atopic Dermatitis [relates] Fragrance Allergy Essential Oils [causes] Fragrance Allergy

‘Unscented’ vs ‘fragrance-free’. The AAD tells parents to choose fragrance-free, not unscented, products. “Unscented” means a fragrance has been added to mask other smells. “Fragrance-free” means no fragrance at all, including ones you cannot smell (AAD). The label does not guarantee this. Baby products marketed as “hypoallergenic” and even “fragrance-free” have been found to contain fragrance, often as a masking agent (Tam & Yu 2022). See Fragrance-Free Labelling.

Conflict: [AAD, n.d.] defines “fragrance-free” as free of all fragrances, even ones you cannot smell. [Tam & Yu, Curr Allergy Asthma Rep, 2022] report that baby products labelled “fragrance-free” often contained fragrance. Unresolved — add to open_questions.

Fragrance-Free Labelling [relates] Fragrance Allergy American Academy of Dermatology [supports] Fragrance-Free Labelling

Botanical extracts as hidden fragrance. “Natural” products can be fragrance sources even when “parfum” is not on the label. Plant oils and extracts carry the same terpenes (linalool, limonene) as perfumes. More than a third of people with Compositae Allergy are also allergic to fragrances, balsam of Peru and colophony, which are all plant-derived (DermNet). Chamomile, Calendula and essential-oil-scented Shea Butter balms can therefore cause a fragrance-type reaction in a child whose parents believe the product is unscented.

Compositae Allergy [relates] Fragrance Allergy Chamomile [triggers] Fragrance Allergy

Labelling rules. In North America, labels need only say “fragrance” or “parfum”, so a sensitised child has to avoid all scented products (Tam & Yu 2022). EU rules are stricter. Fragrance can be listed as “parfum”, but named fragrance allergens must be listed individually above 0.001% in leave-on products and 0.01% in rinse-off products. Regulation (EU) 2023/1545 added 56 allergens to the original 24. Since 31 July 2026, non-compliant products cannot be newly placed on the EU market, but older stock can be sold until 31 July 2028 (European Commission). For parents, this means a leave-on emollient sold in the EU should name any listed allergen present above 10 ppm. A US product may hide the same allergen under “fragrance”.

EU Cosmetics Regulation [regulates] Fragrance Allergy

Fragrance and essential oils on broken skin

Eczematous skin absorbs fragrance allergens more readily. Avoid scented, “unscented” and essential-oil-containing products on a toddler with eczema. Use fragrance-free products, and check the ingredient list, not the front label (AAD; Tam & Yu 2022).

Connections

• Allergic Contact Dermatitis — major paediatric allergen group, source: Tam & Yu 2022
• Essential Oils — linalool/limonene hydroperoxides missed by fragrance mixes, source: Tam & Yu 2022
• Shea Butter — scented/whipped shea products a fragrance source, source: Tam & Yu 2022; r/moderatelygranolamoms (anecdotal)
• Atopic Dermatitis — FM I/II positive more often in children with AD, source: Bonamonte 2022
• Patch Testing — FM I/II + balsam of Peru + linalool/limonene hydroperoxides, source: Tam & Yu 2022
• Fragrance-Free Labelling — ‘unscented’ masks fragrance; choose fragrance-free, source: AAD
• Compositae Allergy — >1/3 co-allergic to fragrance/balsam of Peru, source: DermNet
• Chamomile — botanical source of fragrance-type allergens, source: DermNet
• Calendula — botanical extract in “natural” baby products, source: DermNet
• EU Cosmetics Regulation — 24 + 56 fragrance allergens individually labelled above 0.001% leave-on, source: European Commission 2023/1545
• American Academy of Dermatology — recommends fragrance-free over unscented, source: AAD
• Seal of Acceptance — NEA mark excludes many fragrance allergens, source: NEA Seal page
• Laundry Detergents — fragranced detergents a by-proxy exposure, source: NES; AAD