Objective: To determine the frequency of responses to four mixtures of fragrance materials in routine clinic patients undergoing patch testing for suspect allergic contact dermatitis. The validity of using fragrance: mixtures alone, or in combination, was evaluated in terms of predicting allergy to fragrance judged on the basis of finding a response to at least one of the fragrance mixtures. Methods: A total of 752 subjects were patch tested in five centers worldwide with (1) fragrance mix 8% (FM), (2) balsam of Peru 25%, (3) a mixture of seven of the eight FM 8% ingredients and other fragrance ingredients including jasmine absolute (jasmine/FM mix), and (4) a mixture of five selected natural fragrance ingredients (NM). Results: Of 752 subjects, 100 (13%) had positive patch tests to at least one of the four fragrance mixtures. The age of the patients was 45.2 ± 18.3 years (mean ±SDL Ninety-six percent were Caucasian. Facial eruptions and hand involvement were the most common topographic sites. Of subjects exhibiting a positive response, 67% reacted to FM, 63% to the jasmine/FM mix, 47% to the NM, and 38% to balsam of Peru. Testing with FM and NM identified 84% of the perfume-allergic patients. FM 8% tested simultaneously with the jasmine/FM mix identified 86% of the perfume-allergic patients. Testing simultaneously with three test materials combining either the NM or the jasmine/FM mix with balsam of Peru and FM identified 95% of the perfume-sensitive patients. Conclusions: The simultaneous testing of NM or jasmine/FM mix, in addition to the conventional use of FM 8% and balsam of Peru, increases the sensitivity of testing for fragrance allergy from 81% to 95%.
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