Every fact on this site, with its evidence grade, its caveats and a link to the source.
We start you on the strong ones: findings that have been replicated or come from one large, well-controlled study. Moderate and weak facts are here too, labeled for what they are. Use “Link to this fact” to share a single card.
Skin allergy / Review of other studies
EU scientific advisers (SCCS 2012) list 82 fragrance ingredients as established causes of skin allergy in people.
Strong evidence: Cite SCCS 2012 directly; this review is low reliability.
Source: Kumar 2020 (SCCS 2012), Journal of Cosmetic Dermatology Link to this fact
Skin allergy / Measured in people or real products
In 658 Danish/Swedish patients with hand eczema, 67 (10.2%) reacted to fragrance chemicals commonly found in household products, and the standard fragrance-mix patch test alone would have missed more than half of these reactions.
Strong evidence.
Caveats
Clinic-referred hand-eczema population, not the general public. Confirmed directly against the full primary (Heydorn et al. 2003, Contact Dermatitis 48:317-323), not just its PubMed abstract or Kumar 2020's secondary table.
Source: Kumar 2020 (Heydorn 2003), Journal of Cosmetic Dermatology Link to this fact
Skin allergy / Measured in people or real products
The fragrance chemicals most often found in household products were mostly not in the standard fragrance-allergy patch test used at the time: 6 of its 8 chemicals were in 12% of products or fewer.
Strong evidence.
Caveats
Frequency in products is not the same as clinical sensitization rate; FM II and hydroperoxide testing later added. Clinically confirmed in Heydorn et al. 2003 (n=658 hand-eczema patients, 3 centers): only 3 of the 14 chemicals selected from this paper's household-product survey were FM I constituents, and FM I caught only 45.5% of the fragrance-allergic patients (5.6% of all patients tested missed). The exposure-frequency leader, limonene (78% of products), caused only 0.8-0.9% oxidized-limonene reactivity clinically — product frequency of a chemical still does not predict its clinical allergy rate.
Source: Rastogi 2001, Contact Dermatitis Industry-funded Link to this fact
Skin allergy / Measured in people or real products
Common scent chemicals such as linalool hardly cause allergy when fresh, but once exposed to air they form new chemicals that do: in 1,511 dermatitis patients at six European clinics, 1.3% were allergic to air-oxidized linalool (later studies with a stronger test found about 7%).
Strong evidence.
Caveats
Dermatitis patients, not general population; 2005 test concentration (2.0% pet.) was later shown too low. Clinical relevance no longer just inferred: Andersch Björkman 2014 (ROAT) shows patients identified this way go on to develop dermatitis from twice-daily use of a cream/perfume containing oxidized linalool at concentrations as low as 0.3% (0.056% linalool hydroperoxides, ~27 µg/cm²) — inside the 0.1–2% range measured for individual fragrance ingredients in real products.
Skin allergy / Animal study
Common fragrance chemicals such as limonene (citrus) and linalool (lavender) react with air to form far stronger skin allergens; in mouse tests, oxidized limonene was about 10 times more potent than fresh limonene.
Strong evidence: Mouse LLNA potency; review of replicated data.
Skin allergy / Measured in people or real products
In European skin clinics, 2.8-5.2% of patients tested for dermatitis reacted to oxidized limonene.
Strong evidence: Consecutive dermatitis patients, not general population.
Skin allergy / Review of other studies
About 1 in 22 European adults (4.5%) tested positive to at least one of six fragrance-related patch-test markers (2008-2011); single fragrance markers pick up 1-3%, and up to 16% of patients referred for patch testing react.
Strong evidence: The 4.5% is a six-marker union including non-fragrance markers (colophonium, sesquiterpene lactones), with no clinical-relevance criterion.
Source: Sukakul 2024, Acta Dermato-Venereologica Industry-funded Link to this fact
Skin allergy / Measured in people or real products
In patch tests of 2,900 dermatitis patients in six countries, 5.2% were allergic to oxidized limonene and 6.9% to oxidized linalool, two of the most common fragrance chemicals.
Strong evidence: Clinic population, not general public.
Source: Bråred Christensson 2016, Contact Dermatitis Industry-funded Link to this fact
Skin allergy / Measured in people or real products
Fresh limonene and linalool rarely cause allergy (0.1-0.3% of patients); the allergens form when these chemicals react with air, which also happens in essential oils and perfumes during storage.
Strong evidence: Parent-compound rates cited from IVDK/Danish data.
Source: Bråred Christensson 2016, Contact Dermatitis Industry-funded Link to this fact
Skin allergy / Measured in people or real products
In 2,900 dermatitis patients tested at nine clinics in Europe, Asia and Australia, 6.9% were allergic to air-oxidized linalool, the form a common floral scent chemical found in most perfumes, cosmetics and many cleaners takes after contact with air.
Strong evidence: Dermatitis patients, not general population; 72% weak reactions; range 3-14% by clinic.
Source: Christensson 2012, Contact Dermatitis Link to this fact
Skin allergy / Measured in people or real products
60.5% of patients allergic to oxidized linalool would never have learned they had a fragrance allergy from the standard fragrance patch tests.
Strong evidence: Dermatitis patients.
Source: Christensson 2012, Contact Dermatitis Link to this fact
Skin allergy / Measured in people or real products
80% of patients allergic to oxidized linalool whose products were checked were using fragranced products, mainly shampoos, soaps and creams.
Strong evidence.
Caveats
Linalool confirmed in their products in 38%; clinical relevance established in 41%. Andersch Björkman 2014 (ROAT), drawn from this same 2,900-patient cohort's Gothenburg patients, causally confirms the exposure-effect link: repeated open application of oxidized-linalool-containing cream/perfume at real-product concentrations (down to 0.3%) reproduced dermatitis, and participants who had already avoided linalool-containing products mostly reported improvement.
Source: Christensson 2012, Contact Dermatitis Link to this fact
Skin allergy / Review of other studies
Limonene and linalool become skin allergens when they react with air: in European dermatitis clinics, 3.9-20% of patients tested reacted to oxidized linalool and 1.4-13.7% to oxidized limonene, against under 1% for the fresh chemicals.
Strong evidence: Clinic patients referred for patch testing, not general population.
Skin allergy / Review of other studies
Standard allergy tests with fresh limonene and linalool miss most of these allergies, so European experts now recommend adding the oxidized forms to routine patch testing.
Strong evidence.
Skin allergy / Measured in people or real products
Among 5,773 people tested for eczema at a Swedish hospital, 9.4% were allergic to the air-oxidized forms of two of the most widely used scent chemicals: linalool (7.0%) and limonene (5.1%).
Strong evidence: Clinic population referred for suspected contact allergy; single center.
Skin allergy / Review of other studies
Scent chemicals such as limonene and linalool rarely cause skin allergy when fresh, but once exposed to air they turn into much stronger allergens; the older the product, the more of them it contains.
Strong evidence: Review of experimental and clinical work; no new data.
Source: Karlberg & Lepoittevin 2021, Contact Dermatitis Link to this fact
Skin allergy / Measured in people or real products
Even the fragrance industry's own safety institute classes the cinnamon-scent chemicals cinnamal and cinnamyl alcohol as human skin sensitizers: in its volunteer tests, 29 of 451 people became allergic to cinnamal at 1% or more.
Strong evidence: Industry-run HRIPT/maximization panels, mostly unpublished RIFM reports; 0/≈200 sensitized at ≤0.5%.
Source: RIFM Expert Panel 2005, Food and Chemical Toxicology Industry-funded Link to this fact
Skin allergy / Measured in people or real products
In people already allergic to cinnamal, a deodorant with just 0.01% of it triggered a reaction in 1 of 9, and 0.032% in 4 of 9; the industry limit is 0.05%, and it was set to prevent new allergies, not reactions in people already sensitized.
Strong evidence.
Caveats
Confirmed by the primary source, now in our evidence base: Bruze et al. 2003, an independent (non-industry, no COI declared), double-blind provocation study with a 20-patient non-allergic control group (0/20 reacted) and P<.001 statistics tying the reaction to both cinnamal-sensitization and the actively-scented axilla. The study's own authors recommend a deodorant limit below 0.01%, stricter than the 0.05% IFRA cap.
Source: RIFM Expert Panel 2005 (citing Bruze 2003), Food and Chemical Toxicology Industry-funded Link to this fact
Skin allergy / Measured in people or real products
The fragrance industry's own safety review of the rose ketone cis-beta-damascone records that 10 of 50 human volunteers became sensitized when it was patch tested at 5%, and that the test had to be stopped early because of the number of skin reactions.
Strong evidence: 5% is roughly 100x a fine-fragrance use level (max reported 0.02%); at 0.05% two panels gave 0/53 and 0/28.
Source: Lalko 2007 (RIFM), Food and Chemical Toxicology Industry-funded Link to this fact
Skin allergy / Measured in people or real products
Rose ketones are a real but uncommon allergen: 0.5% of 1606 consecutive European patch-test patients reacted to a 0.2% damascone mixture, and none of 202 Japanese dermatitis patients reacted at 2%.
Strong evidence: Clinic populations, elicitation prevalence not induction risk; original data are Frosch 2002 and Kozuka 1996, reported via the RIFM review.
Source: Lalko 2007 (RIFM), Food and Chemical Toxicology Industry-funded Link to this fact
Skin allergy / Measured in people or real products
About 1 in 5 people in the general population (20.1% of 20,107 people patch tested in 28 studies) are allergic to at least one common chemical that touches the skin, such as nickel, fragrance, preservatives or hair dye.
Strong evidence: Meta-analysis, very high heterogeneity (I2 97%); mostly nickel; publication bias detected.
Skin allergy / Measured in people or real products
After nickel, the standard fragrance allergy test (Fragrance Mix I) was the most common positive in the general population: about 3.5% reacted, across 19 studies and 19,440 people.
Strong evidence: Pooled 1966-2017 (CI 2.1-5.4%); the largest modern study found 1.8-2.6% for the same test.
Skin allergy / Review of other studies
The standard fragrance patch test covers only 8 of the 82 fragrance chemicals known to cause allergy in people, so any single test undercounts fragrance allergy.
Strong evidence: Authors' discussion; oxidized limonene/linalool never tested in a general-population sample.
Skin allergy / Measured in people or real products
Among about 4,100 North American patients referred for allergy patch testing in 2019–2020, 12.8% reacted to the standard fragrance mix and 11.1% to oxidized linalool, both among the ten most common skin allergens and both up from 2017–2018.
Strong evidence: Referral population, not the general public; primary is DeKoven 2023 (NACDG), cited by the review.
Skin allergy / Review of other studies
Common fragrance ingredients such as limonene and geraniol turn into stronger skin allergens when they react with air in an opened bottle.
Strong evidence: Review relay only; the numbers come from the primary autoxidation studies on the transformation-products hub.
Source: Khalid & Abdollahi 2021, Iranian Journal of Pharmaceutical Research Link to this fact
Skin allergy / Measured in people or real products
The industry's safety panel cleared linalool, a lavender-scented chemical in most fragranced products, as raising 'no safety concerns' after testing the fresh chemical; independent clinics later found that air-exposed (oxidized) linalool causes allergic reactions in about 7% of patients patch-tested for skin allergy (2,900 patients in 9 centers; 5,773 in Sweden, with rates rising).
Strong evidence: Clinic rates are in dermatitis patients, not the general population; test preparations debated; fresh linalool is genuinely a weak sensitizer.
Source: Bickers 2003 (RIFM Expert Panel), Regulatory Toxicology and Pharmacology Industry-funded Link to this fact
Skin allergy / Industry source
The industry once allowed the allergen citral only if mixed with a companion terpene (originally tested at about 20% d-limonene, later mandated at ≥25%), claiming the terpene 'quenched' the allergic reaction; the original 1976 evidence for this was a single unreplicated human test with no subject numbers reported and was already internally inconsistent, later industry HRIPTs could not reproduce quenching for a related aldehyde (cinnamaldehyde), and air-oxidized limonene, the proposed quencher, is itself now one of the commonest fragrance allergens (about 5% of patients tested).
Strong evidence.
Caveats
The failed replication documented in our evidence base is for cinnamaldehyde + eugenol/limonene, not citral + limonene itself; IFRA's formal withdrawal of the quenching rule is not documented in our evidence base. The founding 1976 test (Opdyke) also showed the effect failing at a different ratio of the same ingredients (cinnamic aldehyde:eugenol 2.5:1 sensitized where 1:1 had not), and its own essential-oil control (cinnamon bark oil) itself sensitized, contradicting the paper's own summary.
Source: Ford 1994 (RIFM) Industry-funded Link to this fact
Skin allergy / Animal study
Many fragrance chemicals become stronger skin allergens after the bottle is opened: limonene, linalool and geraniol react with air at room temperature to form hydroperoxides that, in mouse tests, sensitize at 5-10 times lower concentrations than the fresh chemical.
Strong evidence: Potency from mouse LLNA; cite Karlberg 2013 as primary; clinic data (Bråred Christensson, Sukakul) confirm oxidized forms are common human allergens.
Source: Pastor-Nieto 2021 (Karlberg 2013), Current Treatment Options in Allergy Link to this fact
Skin allergy / Lab study (cells or chemistry)
Chemicals that only become allergens after they are changed by air or by the skin's own enzymes are the worst-predicted group in the industry's own analysis (4.5- to 6.5-fold error, versus about 2-fold for directly reactive chemicals), because the dish assays cannot oxidize or metabolize anything.
Strong evidence: N=32 chemicals in the worst domain; TIMES-software-assigned mechanistic class, not exhaustively confirmed in vivo.
Source: Natsch 2015, Toxicological Sciences Industry-funded Link to this fact
Skin allergy / Measured in people or real products
In a double-blind study, deodorants containing as little as 0.01% cinnamic aldehyde (cinnamal) triggered allergic skin reactions within weeks in people already allergic to it, while an identical unscented deodorant on the other armpit, and the same deodorants used by 20 non-allergic people, caused no reactions.
Strong evidence.
Caveats
Small cohort (9 sensitized test patients, double-blind arm), but statistically significant (P<.001) with a concurrent negative control group and randomized/blinded contralateral-axilla design.
Source: Bruze et al. 2003, Journal of the American Academy of Dermatology Link to this fact
Skin allergy / Measured in people or real products
For people already allergic to oxidized linalool (the air-exposed form of a common floral fragrance chemical), using a scented cream or perfume containing it at concentrations similar to real products (as low as 0.3% oxidized linalool, 0.056% linalool hydroperoxides) was enough to trigger eczema within three weeks of twice-daily use in a repeated-use trial.
Strong evidence.
Caveats
Small N (6 completers); participants were pre-selected as already patch-test-positive, not a general-population sample; lowest concentration tested (0.1% in perfume) did not produce a formal positive.
Source: Andersch Björkman 2014, Contact Dermatitis Link to this fact
Skin allergy / Measured in people or real products
A positive patch test for oxidized linalool is not just a lab artifact: patients who test positive also develop real dermatitis from everyday-strength fragranced products used the way a consumer would use them, not only from the strong test doses used in the clinic.
Strong evidence: No irritant reactions occurred in vehicle controls, so the effect is allergic rather than irritant; the reverse case (a general population screen) was not tested here.
Source: Andersch Björkman 2014, Contact Dermatitis Link to this fact
Skin allergy / Measured in people or real products
In a controlled study, everyone already allergic to limonene hydroperoxides (11/11) developed a skin reaction within about a week of daily exposure to fine-fragrance-level doses of oxidized limonene (140 ppm and up); healthy people (0/17) had no reaction even at the highest dose tested.
Strong evidence: Single multicenter study; 11 allergic subjects and 17 controls.
Skin allergy / Measured in people or real products
In a 2015 survey of 187 US pediatric personal-care products marketed as hypoallergenic, dermatologist-recommended, fragrance-free or paraben-free, 89% (167/187) contained at least one contact allergen from the standard NACDG screening tray, with a mean of 2.4 allergens per product.
Strong evidence.
Caveats
Single-metro US convenience sample (six unnamed Redlands, CA retailers, 2013), label-based (no chemical verification, no concentrations), and allergen matching by an unaudited custom algorithm; the four marketing-term categories overlap (a product can carry more than one), so subgroup percentages are not independent comparisons.
Source: Hamann 2015, Journal of Allergy and Clinical Immunology Link to this fact
Skin allergy / Measured in people or real products
In a patch test of 3,119 people randomly sampled from the general population of five European countries, 2.6% tested positive to fragrance mix I and 1.9% to fragrance mix II, and 1.9% had a fragrance allergy judged clinically relevant (skin symptoms plus product avoidance).
Strong evidence.
Caveats
The largest, best-controlled general-population fragrance patch-test study to date (n=3,119 of 12,377 interviewed, harmonized protocol across 5 countries); the raw marker-positive rate is higher (4.1%) before the clinical-relevance filter, and about half of marker-positive people do not meet the stricter definition.
Source: Diepgen 2015 (EDEN), British Journal of Dermatology Industry-funded Link to this fact
Skin allergy / Measured in people or real products
In a clinical study of 658 hand-eczema patients across 3 European centers, 67 (10.2%) reacted on patch testing to at least one fragrance chemical selected because it is common in household cleaning and personal-care products used on the hands.
Strong evidence: Clinic-referred hand-eczema population (3 tertiary centers), not a random sample of the general public.
Source: Heydorn 2003, Contact Dermatitis Industry-funded Link to this fact
Skin allergy / Measured in people or real products
More than half (54.5%) of the hand-eczema patients allergic to household-product fragrance chemicals would not have been identified by the standard Fragrance Mix I patch test alone.
Strong evidence: Applies to this hand-eczema clinic population and this specific 14-chemical panel; FM II (2008) and hydroperoxide testing have since narrowed but not closed the gap.
Source: Heydorn 2003, Contact Dermatitis Industry-funded Link to this fact
Skin allergy / Review of other studies
Oxidized forms of limonene and linalool, formed when these common fragrance terpenes react with air, are now treated as a standard, distinct fragrance-allergen category in mainstream dermatology, alongside fragrance mix I/II and balsam of Peru.
Strong evidence.
Caveats
This 2025 general-ACD review reflects consensus classification, not new prevalence data; primary prevalence numbers should be cited from Sukakul 2022, Bråred Christensson 2016/2012, or the EECDRG review already in our evidence base, not this source.
Source: Aristizabal-Torres 2025, JAAD Reviews Link to this fact
Information, not medical advice. See also: myths we won’t tell you.