Lyral® is an important sensitizer in patients sensitive to fragrances

Contact allergy to fragrances is a common problem world-wide, The currently used fragrance mix (FM) for patch testing has only eight constituents and does not identify all fragrance-allergic patients, As perfumes may contain 100 or more substances, the search for markers for allergy continues, The synthetic fragrance 4-(4-hydroxy-4-methylpentyl)-3-cyclohexene carboxaldehyde (Lyral(R)) was tested together with the FM and 11 other fragrance substances on consecutive patients in six European departments of dermatology. All patients were carefully questioned regarding a history of reactions to scented products in the past and were grouped into four categories: 'certain', 'probable', 'questionable' and 'none'. Lyral(R) (5% in petrolatum) gave a positive reaction in 2.7% of 1855 patients (range 1.2-17%) and ranked next to 11.3% with FM allergy, Twenty-four patients reacted to both Lyral(R) and FM, but 21 (1.1%) reacted positively only to Lyral(R). Of 124 patients with a 'certain' history, 53.2% reacted to the FM and a further 7.2% to Lyral(R) only, If any kind of history of fragrance intolerance was given, 80% (40 of 50) of Lyral(R) positive patients had a 'positive' history while only 58.6% (123 of 210) of FM positive patients had such a history; this difference was significant at P < 0.01. Lyral(R) was identified by gas chromatography-mass spectrometry in some products which had caused an allergic contact dermatitis in four typical patients who showed a patch test positive to Lyral(R) and negative or doubtful to FM, In conclusion, we recommend the testing of 5% Lyral(R) (in petrolatum) in patients suspected of contact dermatitis.