Fragrances or pleasant aromas are an integral part of our everyday lives. From the perfumes we use to the spices we eat, there is a fragrant component in everything. Fragrances, though meant to have a positive effect, do have their negative outcome in individuals who are allergic to them. This is known as fragrance sensitivity.

The North American Contact Dermatitis Group (NACDG) classifies fragrances as the fourth most common allergen, accounting for 11.7% of all contact dermatitis cases. NACDG also marks fragrances as the most common cosmetic ingredient to cause allergic contact dermatitis (ACD).

Among fragrances, balsam of Peru, or scientifically myroxylon pereirae, is one of the most widespread allergens. It occurs naturally and the NACDG rates it as the third most prevalent allergen. The International Fragrance Association recommends its repression as a fragrance component.

Initially balsam of Peru was also a vital means of testing for fragrance allergy before the implementation of an easier method with a fragrance mix developed in the 1970s. In fact, it could effectively identify an estimated 50% of cases sensitive to fragrance.

Sources of Balsam of Peru allergens

As a fragrance, balsam of Peru is found in personal use and cosmetics products such as:

• Perfumes
• Bath essence
• Body sprays and deodorants
• Domestic items
• Aromatic skin or hair products

However, sensitivity to balsam of Peru is not restricted to fragrance alone; it can also be triggered from the following direct food sources:

• Spices
• Colas
• Tobacco
• Wines
• Vermouth

Other than these obvious sources, there are some important implicit sources as well. They are:

• Though fragrances are primarily used as pleasant aroma, it also often works to camouflage a distasteful scent. These are called ‘masking fragrances’ and found in products labeled ‘unscented’.
• There are some fragrance elements that act as preservatives or emollients.

Balsam of Peru, benzylaldehyde, benzvl alcohol and bisbalol are some of the conventional covert fragrances.

How to avoid Balsam of Peru allergy

Those who suffer from balsam of Peru allergy need to be actively counseled on how to avoid fragrances. There are two ways to go about it:

1. Avoidance of balsam of Peru products (used as a fragrance ingredient or to mask fragrances): Balsam of Peru used as a fragrance is an obvious form and can be avoided by active label reading for product ingredient information. The Cosmetic, Toiletry, and Fragrance Association furnishes information on product making and contents distinctive to various preparations. However, for knowing about fragrance masking a patient needs to be sufficiently educated about the category of products that are marked as unscented. As explained earlier, these are products that can consist of fragrances used to mask unpleasant odors. Hence, allergic individuals should know that they should look out and use only those products that are labeled as ‘fragrance free’. This of course entails the comprehensive declaration of product ingredients despite their purpose. However, this is still far from an industry convention.

2. Balsam of Peru avoidance diet: Fragrance allergy is related to systemic contact dermatitis that results from the exposure to an allergen by means of drug/chemical/food ingestion, inhalation, injection or percutaneous penetration (intramuscularly, intravenously, orally, rectally, or vaginally).

It causes the following conditions:

• Stomatitis
• Cheilitis
• Generalized or resistant palmar dermatitis
• Plantar or anogenital dermatitis

Persons allergic to balsam of Peru are often systemically allergic to some spices and foods that form a part of our diet. They can safeguard against allergy by a dietary avoidance of balsams. These patients should go on a four-week long trial of an avoidance diet and note the results. If there is noteworthy relief then the patient should avoid the triggering food ingredients on a long-term basis. Thereafter, one food item (at a time) can be tried out after sometime to find out specific ones that aggravates the condition.

There are three categories of patients who should strictly limit balsam-based foods. They are:

• Patients who has been suffering from chronic dermatitis for at least a year and with no respite even after avoidance of skin contact with recognized allergens.
• Those with dermatitis that equally affects the hands and feet, the anogenital area and the skin creases.
• Those who have reported a positive patch test to balsam of Peru and/or fragrance mix.

Last but not least, here is the list of foods that a patient with balsam of Peru allergy should avoid:

• Spices: These include cinnamon, cloves, vanilla, curry, allspice, anise, ginger and Jamaican pepper. Spicy food seasonings for example ketchup, chili sauce, barbecue sauce, chutney and liver paste. Chili found in pizzas and other Italian and Mexican fares that are garnished with spicy red sauces.
• Citrus products: Preparations that contain citrus fruits such as oranges, lemons, grapefruit, bitter oranges, tangerines and mandarin oranges. These include marmalades, juices and bakery items.
• Flavoring substances: Flavors like those added to Danish pastries and various forms of bakery items, candy and chewing gum.
• Drinks: Wine, beer, gin, and vermouth (a wine flavored with herbs). Cola and spiced soft drinks.
• Pickles and pickled vegetables.
• Beverages: Aromatic or flavored tea.
• Tobacco: Mostly mentholated tobacco items.
• Cough medication: This includes some cough drugs and lozenges
• Milk products: Ice cream and chocolate.
• Tomatoes and tomato-based food.