The Patient Perspective

To the Editor: In the US, 3.5% of the population has allergic contact dermatitis to fragrance.1 Based on the North American Contact Dermatitis Group data, fragrances were the fourth most common allergen.2 It can be difficult to avoid fragrance, which are virtually ubiquitous in everyday products. Even products labeled as “unscented” or “fragrance-free” may still contain a fragrance. The Contact Allergen Management Program contains a list of fragrance-free products, but it is not comprehensive. Fragrance are also one of the most common causes of airborne contact dermatitis. However, patients have limited control over, or knowledge of, the products used in public environments. Experts have proposed using barrier creams that might prevent airborne allergens from contacting skin, but there have not been formal studies demonstrating their efficacy.3 Fragrance can restrict individuals from accessing the most necessary of locations, such as public restrooms. The pervasiveness of airborne fragrances in public can necessitate meticulous planning for each outing, and new places are even more of a challenge. “Every time I go to a new location, I have to inquire what products are used,” explained Ms Brodd, a patient with allergic contact dermatitis. “Sometimes, there are power dynamics in play, such as in the workplace, and I end up having to deal with my reaction.” Similarly, Ms Ault and a friend recently encountered difficulties with newly installed fragrance machines at a health club chain. The chain's leadership and the fragrance company provided similar statements that the fragrances are “safe” because their fragrance suppliers are part of the International Fragrance Association. The International Fragrance Association is a self-regulatory global representative body of the fragrance industry. Even with assistance from her dermatologist, the general manager of the club only agreed to unplug the scent machine 15 minutes before Ault's arrival. Is this a violation of the US Americans with Disabilities Act (ADA)? The ADA defines disability as “a physical or mental impairment that substantially limits 1 or more major life activities of such individual.”4 These major life activities can include caring for oneself, concentrating, and working. The ADA prohibits discrimination based on disabilities in employment, public services, and privately owned public accommodations. However, receiving a reasonable accommodation due to their disability is challenging for individuals with fragrance allergy. The solution may not be found in the courts, but in developing fragrance-free policies, which have started to gain momentum in businesses and institutions. A fragrance-free policy may be an equitable option for a business with a patron who has a fragrance allergy. The Centers for Disease Control and Prevention has prohibited fragranced products in “all interior space owned, rented, or leased” by the Centers for Disease Control and Prevention since 2009.5 The Canadian Centre for Occupational Health and Safety provides useful fact sheets on how to implement scent-free policies.6 Steps to consider include the following: conducting an employee survey to assess the issue, creating a representative committee to draft a policy, providing education to all employees about the reasoning behind the policy, addressing concerns honestly, and being open to revision. Guidelines should stress that this policy applies to everyone and that fragrance-containing products are not limited to perfume and cologne. Other useful tips include posting a list of approved unscented products, reviewing ingredients of products used by your organization, and placing policy statement notices in visible areas. Malina Yamashita Peterson, BS Department of Dermatology Park Nicollet Health Services Minneapolis, MN University of Minnesota Medical School Minneapolis [email protected]Michelle Xiong, BS Department of Dermatology Park Nicollet Health Services Minneapolis, MN Warren Alpert Medical School of Brown University Providence, RIMelanie Ault, BA, JD, MAPA, CAPALiz Brodd, BSKristi Harvey, BSN, RNHeather Meng, MA, BS, BA Contact Dermatitis Discussion Group Participant and AdvocateSara Hylwa, MD Department of Dermatology Park Nicollet Health Services Minneapolis, MN Department of Dermatology University of Minnesota Minneapolis

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