cqvip:The currently used 8%fragrance mix (FM I) does not identify all patients with a positive history of adverse reactions to fragrances. A new FM II with 6 frequently used chemicals was evaluated in 1701 consecutive patients patch tested in 6 dermatological centres in Europe. FM II was tested in 3 concentrations-28%FM II contained 5%hydroxyisohexyl 3cyclohexene carboxaldehyde (Lyral.), 2%citral, 5%farnesol, 5%coumarin, 1%citronellol and 10%α-hexyl-cinnamic aldehyde; in 14%FM II, the single constituents’concentration was lowered to 50%and in 2.8%FM II to 10%. Each patient was classified regarding a history of adverse reactions to fragrances:certain, probable, questionable, none. Positive reactions to FM I occurred in 6.5%of the patients. Positive reactions to FMII were dose-dependent and increased from 1.3%(2.8%FM II), through 2.9%(14%FM II) to 4.1%(28%FM II). Reactions classified as doubtful or irritant varied considerably between the 6 centres, with a mean value of 7.2%for FM I and means ranging from 1.8%to 10.6%for FM II. 8.7%of the tested patients had a certain fragrance history. Of these, 25.2%were positive to FM I; reactivity to FM II was again dose-dependent and ranged from 8.1%to 17.6%in this subgroup. Comparing 2 groups of history-certain and none-values for sensitivity and specificity were calculated:sensitivity:FM I, 25.2%; 2.8%FM II, 8.1%; 14%FM II, 13.5%; 28%FM II, 17.6%; specificity:FM I, 96.5%; 2.8%FM II, 99.5%; 14%FM II, 98.8%; 28%FM II, 98.1%. 31/70 patients (44.3%) positive to 28%FMII were negative to FM I, with 14%FM II this proportion being 16/50 (32%). In the group of patients with a certain history, a total of 7 patients were found reacting to FM II only. Conversely, in the group of patients without any fragrance history, there were significantly more positive reactions to FM I than to any concentration of FM II. In conclusion, the new FM II detects additional patients sensitive to fragrances missed by FMI; the number of false-positive reactions is lower with FM II than with FM I. Considering sensitivity, specificity and the frequency of doubtful reactions, the medium concentration, 14%FM II, seems to be the most appropriate diagnostic screening tool.
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