Journal of Cosmetic Dermatology
Volume 5 Page 76 - March 2006
Volume 5 Issue 1
Letter to the Editor
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.
Nowadays, reactions to cosmetics constitute a small but
significant proportion of the cases of contact dermatitis.
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
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.
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
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
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
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
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
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:
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:
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:
9 Albin M, Rylander L, Mikoczy Z
et al. Incidence of asthma in female Swedish
hairdressers. Occup Environ Med 2002; 59:
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:
11 Leino T, Tammilehto L, Hytonen M
et al. Occupational skin and respiratory diseases among
hairdressers. Scand J Work Environ Health 1998; 24:
Journal of Cosmetic Dermatology
5 Page 76 - March 2006
It IS the combinations of chemicals,
states UC Professor
Tribune article about pesticides.
It IS the
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)
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.