The role of the skin irritation response in polysensitization to fragrances

Background. Contact allergy to fragrance chemicals is an increasing problem. Polysensitization is likely to be a phenotype of increased susceptibility to contact allergy. The factors that play a role in polysensitization are largely unknown. Identifying these risk factors is important with regard to future studies on the aetiology of contact allergy. Objectives. To investigate whether enhanced skin irritability is a risk factor for the development of polysensitization to fragrance chemicals. Methods. One hundred participants characterized by fragrance contact allergy were included in our study. The participants were patch tested on the back with 25 individual fragrance chemicals and fragrance mixes I and II, and on the upper arm with sodium lauryl sulfate (SLS) (consisting of SLS concentrations of 0.45%, 0.67%, 1%, and 1.5%). Reading of both tests was performed during the following visits at days 2, 3, and 7. The response to SLS was monitored by measuring transepidermal water loss (TEWL). Polysensitization was defined as three or more allergic reactions to non-cross-reacting fragrance chemical allergens. Results. Individuals with polysensitization showed significantly higher irritation responses to SLS 1% and 1.5% as assessed by TEWL. Conclusions. We found an enhanced skin irritation response to be a risk factor for the development of polysensitization to fragrance chemicals