C Wlodek1,2, C M Penfold3, J F Bourke4, M M U Chowdhury5, S M Cooper6, S Ghaffar7, C Green7, C R Holden8, G A Johnston9, A A Mughal10, C Reckling11, R A Sabroe8, N M Stone12, D Thompson13, S M Wilkinson14, D A Buckley1. 1. Royal United Hospital, Bath, U.K. 2. Bristol Royal Infirmary, Bristol, U.K. 3. National Institute for Health Research, Biomedical Research Unit in Nutrition, Diet and Lifestyle, University Hospital Bristol Education Centre, Bristol, U.K. 4. South Infirmary Victoria University Hospital, Cork, Ireland. 5. University Hospital of Wales, Cardiff, U.K. 6. Oxford University Hospitals, Oxford, U.K. 7. Ninewells Hospital, Dundee, U.K. 8. Sheffield Teaching Hospitals NHS Trust, Sheffield, U.K. 9. Leicester Royal Infirmary, Leicester, U.K. 10. Singleton Hospital, Swansea, U.K. 11. East Kent Hospitals, Canterbury, U.K. 12. Royal Gwent Hospital, Newport, U.K. 13. Sandwell & West Birmingham Hospitals, Birmingham, U.K. 14. Leeds Teaching Hospitals NHS Trust, Leeds, U.K.
Abstract
BACKGROUND: There is a significant rate of sensitization worldwide to the oxidized fragrance terpenes limonene and linalool. Patch testing to oxidized terpenes is not routinely carried out; the ideal patch test concentration is unknown. OBJECTIVES: To determine the best test concentrations for limonene and linalool hydroperoxides, added to the British baseline patch test series, to optimize detection of true allergy and to minimize irritant reactions. METHODS: During 2013-2014, 4563 consecutive patients in 12 U.K. centres were tested to hydroperoxides of limonene in petrolatum (pet.) 0·3%, 0·2% and 0·1%, and hydroperoxides of linalool 1·0%, 0·5% and 0·25% pet. Irritant reactions were recorded separately from doubtful reactions. Concomitant reactions to other fragrance markers and clinical relevance were documented. RESULTS: Limonene hydroperoxide 0·3% gave positive reactions in 241 (5·3%) patients, irritant reactions in 93 (2·0%) and doubtful reactions in 110 (2·4%). Linalool hydroperoxide 1·0% gave positive reactions in 352 (7·7%), irritant reactions in 178 (3·9%) and doubtful reactions in 132 (2·9%). A total of 119 patients with crescendo reactions to 0·3% limonene would have been missed if only tested with 0·1% and 131 patients with crescendo reactions to 1·0% linalool would have been missed if only tested with 0·25%. In almost two-thirds of patients with positive patch tests to limonene and linalool the reaction was clinically relevant. The majority of patients did not react to any fragrance marker in the baseline series. CONCLUSIONS: We recommend that limonene hydroperoxides be tested at 0·3% and linalool hydroperoxides at 1·0% in the British baseline patch test series.
BACKGROUND: There is a significant rate of sensitization worldwide to the oxidized fragrance terpenes limonene and linalool. Patch testing to oxidized terpenes is not routinely carried out; the ideal patch test concentration is unknown. OBJECTIVES: To determine the best test concentrations for limonene and linalool hydroperoxides, added to the British baseline patch test series, to optimize detection of true allergy and to minimize irritant reactions. METHODS: During 2013-2014, 4563 consecutive patients in 12 U.K. centres were tested to hydroperoxides of limonene in petrolatum (pet.) 0·3%, 0·2% and 0·1%, and hydroperoxides of linalool 1·0%, 0·5% and 0·25% pet. Irritant reactions were recorded separately from doubtful reactions. Concomitant reactions to other fragrance markers and clinical relevance were documented. RESULTS:Limonene hydroperoxide 0·3% gave positive reactions in 241 (5·3%) patients, irritant reactions in 93 (2·0%) and doubtful reactions in 110 (2·4%). Linalool hydroperoxide 1·0% gave positive reactions in 352 (7·7%), irritant reactions in 178 (3·9%) and doubtful reactions in 132 (2·9%). A total of 119 patients with crescendo reactions to 0·3% limonene would have been missed if only tested with 0·1% and 131 patients with crescendo reactions to 1·0% linalool would have been missed if only tested with 0·25%. In almost two-thirds of patients with positive patch tests to limonene and linalool the reaction was clinically relevant. The majority of patients did not react to any fragrance marker in the baseline series. CONCLUSIONS: We recommend that limonene hydroperoxides be tested at 0·3% and linalool hydroperoxides at 1·0% in the British baseline patch test series.
Authors: Gunnar S A Nyman; Ana Maria Giménez-Arnau; Jurate Grigaitiene; Laura Malinauskiene; Evy Paulsen; Lina Hagvall Journal: Acta Derm Venereol Date: 2021-11-11 Impact factor: 3.875