LyralR is an important sensitizer in patients sensitive to fragrances

Abstract

Contact allergy to fragrances is a common problem world‐wide. The currently used fragrance mix (FM) for patch testing has only eight constituents and does not identify all fragrance‐allergic patients. As perfumes may contain 100 or more substances, the search for markers for allergy continues. The synthetic fragrance 4‐(4‐hydroxy‐4‐methylpentyl)‐3‐cyclohexene carboxaldehyde (Lyral^®) was tested together with the FM and 11 other fragrance substances on consecutive patients in six European departments of dermatology. All patients were carefully questioned regarding a history of reactions to scented products in the past and were grouped into four categories: ‘certain’, ‘probable’, ‘questionable’ and ‘none’. Lyral^® (5% in petrolatum) gave a positive reaction in 2·7% of 1855 patients (range 1·2–17%) and ranked next to 11·3% with FM allergy. Twenty‐four patients reacted to both Lyral^® and FM, but 21 (1·1%) reacted positively only to Lyral^®. Of 124 patients with a ‘certain’ history, 53·2% reacted to the FM and a further 7·2% to Lyral^® only. If any kind of history of fragrance intolerance was given, 80% (40 of 50) of Lyral^® positive patients had a ‘positive’ history while only 58·6% (123 of 210) of FM positive patients had such a history; this difference was significant at P < 0·01. Lyral^® was identified by gas chromatography–mass spectrometry in some products which had caused an allergic contact dermatitis in four typical patients who showed a patch test positive to Lyral^® and negative or doubtful to FM. In conclusion, we recommend the testing of 5% Lyral^® (in petrolatum) in patients suspected of contact dermatitis.