“This perfume makes me sick, but I like it.” Representative survey on health effects associated with fragrances

Fragranced consumer products, including cleaning supplies, laundry products, perfumes, and air fresheners, are ubiquitous and have been linked to adverse health effects. While some fragrance ingredients are legally restricted, many individuals continue to report negative health consequences. Previous nationally representative surveys in the USA, Australia, the UK, and Sweden have shown a high percentage of the population experiencing adverse health effects from fragrance exposure. This study aimed to investigate self-reported health effects associated with fragrance exposure in Germany, focusing on vulnerable subgroups such as those with asthma or self-identified fragrance sensitivity, to better understand their specific experiences and behaviors related to fragrance exposure. The study aimed to answer several research questions, including identifying the most frequently reported effects, understanding the relationship between preference for fragrance-free products and health effects, examining knowledge about fragrance ingredients and their health implications, and analyzing exposure behaviors among different groups. The hypothesis examined whether dermal effects are most prevalent, whether individuals preferring fragrance-free products have fewer health problems, whether younger individuals and women are more likely to read product labels to check fragrance ingredients, whether those reading labels or experiencing health effects are better informed about fragrance chemistry and regulations, whether those with a preference for natural ingredients over synthetic ones assume that natural products are inherently healthier, and whether those reading labels, preferring fragrance-free products, or experiencing health effects reduce their fragrance exposure.

Existing literature highlights the negative health and environmental impacts of several fragrance ingredients. While legal restrictions have been implemented in some regions, like the European Union's Cosmetic Regulation, the number of individuals reporting adverse health effects remains high. Previous national surveys in various countries (USA, Australia, UK, Sweden) reported a significant percentage of the population experiencing such effects. These studies have mainly focused on skin effects, like allergic reactions and irritation, particularly in relation to cosmetic and cleaning products. Studies in Germany have also concentrated on dermal effects and the 26 allergenic fragrance ingredients that require listing in cosmetic product labeling under EU regulations, overlooking other potential fragrance compounds and health impacts beyond skin issues. Data from Germany has often come from dermatological hospital patch test populations, not the general population.

This study utilized an online survey conducted in March 2019 with a nationally representative sample of 1102 German adults aged 18-65. The survey, conducted by Survey Sampling International (SSI), employed a random sample stratified by age, gender, and region. The survey had an 83% completion rate, with all responses anonymized. The questionnaire addressed fragrance product use and exposure, associated health effects, specific exposure situations (workplace and society), preferences for fragrance-free environments, and demographic information. New questions were added compared to previous national surveys to explore attitudes toward fragrances, product label reading habits, perceptions of natural versus synthetic fragrances, and preference for fragrance-free products. The survey defined "fragrance-sensitive persons" as those reporting adverse health effects from fragrance exposure. "Autists" were defined based on self-reported diagnoses. "Asthmatics" were similarly self-defined. Subgroups were created based on responses to specific survey questions (e.g., those preferring fragrance-free products, those using fragrances to feel attractive). The analysis considered the overlap between subgroups. The limitations of the study included the inability to include all possible product types and health effects, reliance on self-reported data, the cross-sectional study design limiting the ability to determine temporal relationships, exclusion of children and the elderly, lack of quantitative exposure data, absence of non-conscious health effect data, and potential bias in linking health problems to fragrance exposure.

The survey revealed that approximately 20% (19.9%) of the German population reported being fragrance-sensitive. Respiratory problems (55.3% of fragrance-sensitive individuals) and mucosal problems (35.6%) were the most frequently reported health effects in this group. A strikingly high percentage (81.6%) of autistic participants reported fragrance sensitivity. Over half the general population (55.6%) incorrectly believed natural fragrance ingredients are healthier than synthetic ones; this misconception was even higher among those reporting adverse health effects. The study found that individuals reporting negative health effects from fragrances reported similar or even higher exposure levels (up to 98.6%) compared to the general population (96.9%). More men than women reported reading product labels to obtain information about fragrance ingredients. While three-quarters of participants used fragrances to feel more attractive, 7.6% still experienced respiratory problems when exposed to fragrances. Analysis of specific health effects showed that respiratory problems were the most prevalent health effect across subgroups, except for autistic participants, who most frequently reported immune system problems. Asthma, fragrance sensitivity, and allergies were frequently reported across subgroups. Autistic participants reported significantly more serious health effects. The study demonstrated that nearly 97% of the general population and a similar proportion of fragrance-sensitive individuals were exposed to fragrances through their own use, while 82% and 95%, respectively, were exposed through others’ use. Those preferring fragrance-free products reported slightly less exposure to air fresheners and perfumes through personal use. The knowledge about fragrance ingredients was relatively low in the general population, with misconceptions about the health implications of natural fragrances being prevalent. Even individuals experiencing health effects frequently exposed themselves to fragrances.

The findings challenge previous assumptions about fragrance-related health effects, particularly the predominance of dermal effects over respiratory issues. The high self-reported exposure among fragrance-sensitive individuals is noteworthy, suggesting a lack of effective risk-reduction behavior. This points to a potential cognitive dissonance, where individuals acknowledge negative health effects yet maintain their fragrance usage. This complex behavior requires further investigation into the motivations behind fragrance use, possibly including cultural norms, social expectations, and the perceived benefits outweighing the negative consequences. The incorrect beliefs about natural versus synthetic fragrance health implications are concerning, highlighting the need for improved risk communication and public education. The low awareness of undisclosed fragrance ingredients and the emission of hazardous air pollutants from both natural and synthetic products emphasizes the need to address information gaps.

This study highlights the significant prevalence of self-reported health problems associated with fragranced products in Germany. The findings underscore the need for improved risk communication, more stringent regulations (such as mandatory ingredient disclosure and bans of hazardous ingredients across product categories), better support for healthcare professionals in diagnosing fragrance-related illnesses, and increased availability of fragrance-free products and environments. Future research should focus on quantitative analyses of cause-effect relationships, identifying specific fragrance chemicals responsible for different health effects, and exploring the cultural and psychological factors influencing fragrance use behavior. Reducing exposure through product reformulation and increased fragrance-free options may prove more effective than solely relying on improved risk communication.

The study’s limitations include its reliance on self-reported data, the cross-sectional design, the age range of participants excluding children and elderly, and the lack of quantitative exposure data. The focus on self-reported health effects may have biased the results, as some participants might have linked their health problems to fragrance exposure even without a direct causal link. The survey's nature prevented the capture of non-conscious health effects. The detailed list of health effects might have influenced the responses, potentially overestimating the prevalence of fragrance-related health problems.