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Journal of Cosmetic Dermatology
Volume 5 Page 76  - March 2006
Volume 5 Issue 1

Letter to the Editor

Do cosmetics cause airway allergy?
Devinder Mohan Thappa

To the Editor

Cosmetics are an important part of our daily life and have been used for thousands of years. Many of us take cosmetics for granted when using soaps, shampoo, and toothpaste for the hygiene of our body. Others expend a great deal of thought, expense, and time in using cosmetics to enhance their physical beauty with make up, hair color, and perfumes. Basically, cosmetics are intended for cleaning, beautifying, and otherwise altering the appearance of skin. The present-day anti-aging generation is determined to look young and sexy until death, which has led to increased use of various cosmetics.

1 Nowadays, reactions to cosmetics constitute a small but significant proportion of the cases of contact dermatitis.

2 Approximately 10% of the adult population may suffer adverse reactions to cosmetics. Skin care and hair products are the most common causes of contact dermatitis from cosmetics. Now the question comes, do cosmetics cause airway allergy. The answer is yes. Contact sensitization to fragrances is one of the commonest causes of contact allergy in the general population as well as among patients with eczema.

3 These adverse cutaneous reactions to cosmetics are varied, including subjective and objective irritation, allergic contact dermatitis, contact urticaria, dyspigmentation, nail dystrophy, hair breakage, and acne. Half of the reported cases of cosmetic dermatitis occur on the face including the eyelids (airway not far away), and 80% of these cases occurs in females. The top three cosmetic allergens are perfumes, preservatives, and hair dyes.

4 Skin exposures to fragrances, exposure to volatiles from consumer products, or from other people wearing perfume, are everyday occurrences; however, they may cause eye and airway symptoms. Individuals with perfume contact allergy and/or hand eczema as opposed to those without have more frequent and more severe eye or airway symptoms after exposure to fragrance products. 'Having hand eczema has the greatest impact on reporting eye and airway symptoms by fragrance products' was the highlight of the recently published study in the British Journal of Dermatology.4 Airborne exposure to potent allergens such as the preservative kathon in sensitized individuals has been reported to result in systemic reaction with contact eczema and immediate respiratory symptoms.5 As yet the mechanism remains undetermined. Fragrance ingredients cause nonimmunological immediate reactions in the skin,6,7 but no data suggest that such symptoms are related to contact allergy. Elberling et al.,4 however, showed consistent and significant associations between perfume contact allergy diagnosed by patch testing and symptoms elicited by fragrance products from the eyes and airways. The symptoms were mostly reported as elicited within seconds or minutes after airborne exposure to fragrance products. The markers of perfume contact allergy used for patch testing were balsam of Peru, colophony, and fragrance mix composed of alpha-amyl cinnamic aldehyde, cinnamic aldehyde, cinnamic alcohol, eugenol, geraniol, hydroxycitronellal, isoeugenol, and oak moss absolute.

Exposures to high concentrations of gases, vapors, and fumes may cause respiratory symptoms and bronchoconstriction by various pathophysiological mechanisms.
8,9 This has been found in workers with high exposure to organic dust and paint, including welding. Employees in a hairdressing salon are periodically exposed to various chemicals in permanent oils, hair dyes, and hair lacquers capable of producing respiratory symptoms.9 In a questionnaire-based study on hairdressers in Bergen, Norway, it was found that hairdressers reported significantly more wheezing, breathlessness, runny eyes, and blocked or runny nose from exposure to hair dyes, permanent oils, bleaching powders, and other chemicals used in a hairdressing salon, compared with the office workers.8 Some of these chemicals are considered to be allergens; other chemicals are irritants, and both may cause acute, nonspecific respiratory tract reactions shortly after exposure. Persulfate salts and hair dyes have for example been associated with chronic and recurring asthma in hair dressers and chemical workers.8,9 Experimentally, hair bleach induces airway hyper-responsiveness in rabbits after a single short-term (4 h) exposure to concentrations of persulfates of around 5-10 mg/m2.10

Hairdressers are exposed to several reactive agents with potentially irritant and sensitizing effects on the airways.9 In a clinical study of hairdressers, hair bleach and the use of aerosol hair sprays were the most provocative factors to increase the respiratory symptoms, and 90% of the diagnosed occupational respiratory diseases were judged to be caused by persulfates in bleaches.11 In a Swedish nationwide study in female hairdressers, an increased risk of asthma was related to exposure to persulfates, and possibly also hair spray.9 Thus, authors suggested that an occupational etiology should be considered when asthma is diagnosed in a hairdresser. In order to overcome the problem from persulfates, a change from powder to less dusty paste, or granular preparations of hair bleach has been suggested. Installation of exhaust ventilation in the mixing areas of bleaching powder and peroxide and improvement of the general ventilation in the salon may help to overcome this problem.

To address this issue of airway allergy as a result of cosmetics, especially with perfumes and fragrance products (skin care lotions, cleansing agents, soap, air fresheners), hair bleaching agents, hair sprays, etc., in addition to being labeled as hypoallergenic, another label pasted may say whether they are suitable for asthmatics or those with airway disease. Maybe in the future, we may have to undertake some kind of predictive test to find the potential of cosmetic products to produce airway symptoms and/or allergy before they are launched in the markets.


Devinder Mohan Thappa

 References  Go to:
 1        Kligman AM. Cosmetics - a dermatologist looks to the future: promises and problems. Dermatol Clin 2000; 18 (4): 699-709.
    2           Maibach HI, Engasser PG. Dermatitis due to cosmetics. In: AA Fisher, ed. Contact Dermatitis, 3rd edn. Philadelphia: Lea & Febiger; 1986: 368-93.
 3      Rietschel RL, Conde-Salazar L, Goossens A, Veien NK. Atlas of Contact Dermatitis. London: Martin Dunitz; 1999: pp. 185.
 4       Elberling J, Linneberg A, Mosbech H et al. A link between skin and airways regarding sensitivity to fragrance products? Br J Dermatol 2004; 151: 1197-203.
    5         Bohn S, Niederer M, Brehm K et al. Airborne contact dermatitis from methylchloroisothiazolinone in wall paint. Abolition of symptoms by chemical allergen inactivation. Contact Dermatitis 2000; 42: 196-201.
     6     Bhalla M, Thami GP. Acute urticaria due to dental eugenol. Allergy 2003; 58: 158.
     7         Mathias CG, Chappler RR, Maibach HI. Contact urticaria from cinnamic aldehyde. Arch Dermatol 1980; 116: 74-6.
    8      Hollund BE, Moen BE, Lygre SH et al. Prevalence of airway symptoms among hairdressers in Bergen, Norway. Occup Environ Med 2001; 58: 780-5.
     9       Albin M, Rylander L, Mikoczy Z et al. Incidence of asthma in female Swedish hairdressers. Occup Environ Med 2002; 59: 119-23.
    10          Mensing T, Marek W, Raulf-Heimsoth M et al. Acute exposure to hair bleach causes airway hyper-responsiveness in a rabbit model. Eur Respir J 1998; 12: 1371-4.
    11    Leino T, Tammilehto L, Hytonen M et al. Occupational skin and respiratory diseases among hairdressers. Scand J Work Environ Health 1998; 24: 398-406.

Journal of Cosmetic Dermatology

Volume 5 Page 76  - March 2006

It IS the combinations of chemicals,

states UC Professor Tyrone Hayes

in Oakland Tribune article about pesticides.


It IS the environment states

Breast Cancer Action and Breast Cancer Fund

in an Oakland Tribune article about breast cancer.


It IS the combination of fragrance chemicals,

as well as individual petrochemically derived chemicals,

state Betty Bridges, RN (FPIN) and Barb Wilkie (EHN)

since petitioning the FDA May 11, 1999.

Write to the FDA . . . tell them to protect your health

by regulating the flavors and fragrance industry.

Put Docket Number 99P-1340 on your subject line.

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