Background: In about half of the patients reacting positive to fragrance mix I (FM I), breakdown testing remains negative. This raises the question of whether the reaction to FM I is false-positive, or the breakdown test is false-negative.
Objectives: To identify characteristics and sensitization patterns of patients positive to FM I, but not to its fragrance constituents.
Patients and methods: Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK) between 2005 and 2019. Three patient groups were defined according to their reaction pattern: Group I, FM I positive and ≥1 single fragrance positive in the breakdown test (n = 1912); Group II, FM I positive and breakdown test negative (n = 1318); Group III, FM I negative (n = 19 790).
Results: Regarding the pattern of concomitant reactions to other fragrances, Group II had an intermediate position between Group I and Group III. In other respects (age and sex distribution, frequency of sensitization to non-fragrance baseline series allergens), Group II rather resembled Group I.
Conclusions: Not every positive reaction to FM I in patients with negative breakdown tests is false-positive. There may be false-negative reactions to the single fragrance components when patch tested at 1% pet. Raising patch concentrations of some single fragrances is recommended.
Keywords: amyl cinnamal; breakdown test; clinical epidemiology; eugenol; fragrance allergy; fragrance mix I; geraniol; patch test concentration; patch testing.
© 2021 The Authors. Contact Dermatitis published by John Wiley & Sons Ltd.