The sign on Joyce Miller’s office door reads: “Please do not wear scented products near this office. Chemicals in scented products can trigger serious health reactions in people with asthma and other sensitivities. I am one of them. Thank you for your consideration!”
A librarian in upstate New York, Miller admits that it took some judicious diplomacy to get permission to mount the sign. She didn’t want to offend her colleagues but she had no choice. After several years of problems breathing at work – during meetings, in a restroom that was badly ventilated and even in her own office – she was shocked when a doctor said she’d developed irritant-induced asthma.
She says exposure to fragrance is definitely her key indoor trigger and is now on daily medication to control it.
Miller also had bouts of eczema after using products such as scented shampoos. “I had no idea that any of this existed,” she says. As a librarian, she did her research, discovering just how commonly perfumed products affect Americans’ health. She now has her own webpage  with information on fragrance sensitivity.
She is in good company, as nearly three-quarters of asthma patients report that fragrances bring on airway symptoms.
“People who are ‘over-cologners’ are generally not aware they’re wearing too much fragrance,” Miller said. “To the rest of us, it’s like getting hit with pepper spray.”
Konrad Ejbich agrees. The professional wine taster based in Toronto says he can actually taste smells on his tongue and that whenever he gets a strong whiff of fragrance or aftershave, he has trouble breathing properly and may get a facial rash. Fortunately, his wife doesn’t wear perfume, but it’s only recently that his mother-in-law has started to get it.
She wears “some kind of cologne and used to get offended when I didn’t kiss her hello,” he says. These days she warns her son-in-law to steer clear if she’s wearing perfume, which he greatly appreciates.
While they can be severe in people with asthma, respiratory symptoms usually fall under the umbrella of irritant, rather than allergic, reactions.
When it comes to the skin, however, the eczema or contact dermatitis  that’s set off by fragrances is true allergy. The immune system reacts to contact with certain scent ingredients with a rash or skin eruption. This can occur anywhere on the body, though often on the face, neck and hands. There may be swelling and redness or a rash a few hours after physical contact, or it can emerge up to a day or two later.
Lisa Garner, a dermatologist in Garland, Texas and vice-president of the American Academy of Dermatology, explains that for most patients to have a contact allergic reaction, the skin must directly touch the fragrance.
In rare cases of this condition, people can be sensitive to ingesting or inhaling perfumed products. Think foods spiced with cloves, cinnamon and nutmeg or breathing in air fresheners. Symptoms in such cases include a breakout around the lips or a widespread rash.
One German study published in the British Journal of Dermatology did find that those with a skin allergy to perfume also “have more frequent and more severe eye or airway symptoms” after exposure to airborne fragrances.
The standard for a definitive diagnosis of contact allergy, including those caused by fragrance, is the patch test, which is exactly what it sounds like.
Patches containing specific allergens are placed on a patient’s back and then the doctor removes them after 48 hours to see which allergens cause the skin to react. The patient is re-examined for reactions a second time within the next three to seven days. As a rule, 48 common contact allergens are the first to be tested, although some spicy and floral-scented fragrance allergens may be grouped together into a kind of allergen bouquet.
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