Thank you for your recent inquiry.
To my knowledge there is only one case of anaphylaxis to perfume reported in the medical literature (see abstract below). However, there are a number of cases of respiratory tract symptoms including cough, wheeze, and rhinitis reported due to the inhalation of fragrances. It is certainly not uncommon, in the practice of Allergy, to hear respiratory complaints that are attributed to the inhalation of perfumes. Challenge studies have documented that such inhalations can produce respiratory tract symptoms (1) (also see Annals of Allergy abstract copied below). However, to my knowledge, there has been no identification of the specific agent(s) in perfumes that has been responsible for these reactions. I could find nothing in particular regarding patchouli oil. Nonetheless, when one looks at the patchouli oil Material Safety Data Sheet (MSDS), one finds the following:
"The inhalation of this oil can cause problems in its unadulterated form. "Liquid may irritate eyes and skin. Liquid may cause dermatitis. Repeated contact may cause allergic and dermatologic reaction."
If inhalation exposure occurs, it states to "remove persons to well-ventilated area and follow normal first-aid procedures. If breathing has stopped, administer artificial respiration and oxygen if available."
In summary, the response to perfume that you described in your patient is not uncommonly seen. The mechanism(s) of production of this response has not been determined, but it is not unlikely to be due to chemoreceptors rather than specifically mediated by IgE as far as the respiratory symptoms are concerned. The one episode of anaphylaxis reported is the only systemic event that I could find in the literature.
Again, as far as patchouli oil is concerned, there is no specific information available other than what one can find in the MSDS sheet.
There is no standardized test for immediate hypersensitivity of which I am aware that will allow you to determine the responsible agent in a given patient. If you used, for example, skin tests, you would be faced with the problem of nonspecific irritation and therefore would have to utilize controls.
As far as treatment is concerned, in the article by Shim and Williams, cromolyn sodium was useful, but it is not available in our market any longer and therefore it would not be of any practical use to you at this point.
Dealing with this issue in the workplace is always a difficult problem. Obtaining cooperation from individuals can be challenging. However, to my knowledge, at this time it is the only practical option that we have.
Thank you again for your inquiry and we hope this response is helpful to you.
The Journal of the American Board of Family Practice, Vol 14, Issue 2 137-140, Copyright 2001 by American Board of Family Practice
Occupational acute anaphylactic reaction to assault by perfume spray in the face
J. E. Lessenger
BACKGROUND: Perfumes have been associated with rashes in employees exposed to scented soaps or with allergic conditions, such as rhinitis or asthma, in employees exposed to perfumes or fragrances in the air. METHODS: Reported here is a case of an anaphylactic reaction and respiratory distress as a result of a deliberate assault with a perfume spray. The medical literature was searched using the key words "fragrances," "respiratory distress," "assault," and "health care workers." RESULTS: A female medical assistant with no history of asthma or reactions to fragrances was assaulted by a patient, who pumped three sprays of a perfume into her face. The employee experienced an acute anaphylactic reaction with shortness of breath, a suffocating sensation, wheezes, and generalized urticaria, and required aggressive medical treatment, a long period of oral bronchodilator therapy, and, finally, weaning from the medications. CONCLUSIONS: Perfumes are complex mixtures of more than 4,000 vegetable and animal extracts and organic and nonorganic compounds. Fragrances have been found to cause exacerbations of symptoms and airway obstruction in asthmatic patients, including chest tightening and wheezing, and are a common cause of cosmetic allergic contact dermatitis. In many work settings the use of fragrances is limited. Assault is becoming more common among workers in the health care setting. Workers should be prepared to take immediate steps should an employee go into anaphylactic shock.
Ann Allergy Asthma Immunol. 1995 Nov;75(5):429-33.
Inhalation challenge effects of perfume scent strips in patients with asthma.
Kumar P, Caradonna-Graham VM, Gupta S, Cai X, Rao PN, Thompson J.
Department of Medicine, Louisiana State University Medical Center, New Orleans, USA.
BACKGROUND: Perfume- and cologne-scented advertisement strips are widely used. There are, however, very few data on the adverse effects of perfume inhalation in asthmatic subjects. OBJECTIVES: This study was undertaken to determine whether perfume inhalation from magazine scent strips could exacerbate asthma. METHODS: Twenty-nine asthmatic adults and 13 normal subjects were included in the study. Histories were obtained and physical examinations performed. Asthma severity was determined by clinical criteria of the National Heart, Lung, and Blood Institute (NHLBI). Skin prick tests with common inhalant allergens and with the perfume under investigation were also performed. Four bronchial inhalation challenges were performed on each subject using commercial perfume scented strips, filter paper impregnated with perfume identical to that of the commercial strips, 70% isopropyl alcohol, and normal saline, respectively. Symptoms and signs were recorded before and after challenges. Pulmonary function studies were performed before and at 10, 20, and 30 minutes after challenges. RESULTS: Inhalational challenges using perfume produced significant declines in FEV1 in asthmatic patients when compared with control subjects. No significant change in FEV1 was noted after saline (placebo) challenge in asthmatic patients. The percent decline in FEV1 was significantly greater after challenge in severely asthmatic patients as compared with those with mild asthma. Chest tightness and wheezing occurred in 20.7% of asthmatic patients after perfume challenges. Asthmatic exacerbations after perfume challenge occurred in 36%, 17%, and 8% of patients with severe, moderate, and mild asthma, respectively. Patients with atopic asthma had greater decreases in FEV1 after perfume challenge when compared with patients with nonallergic asthma. CONCLUSIONS: Perfume-scented strips in magazines can cause exacerbations of symptoms and airway obstruction in asthmatic patients. Severe and atopic asthma increases risk of adverse respiratory reactions to perfumes.
Shim C and Williams MH Jr. American Journal of Medicine 1986 (January); 80(1):18-22.
Phil Lieberman, M.D.