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

The study examines self-reported health effects associated with exposure to fragranced consumer products in Germany and contrasts responses across vulnerable subgroups (e.g., asthmatics, autists, and fragrance-sensitive individuals). Motivated by prior nationally representative surveys in the USA, Australia, the UK, and Sweden that found 28.7–34.7% of populations reporting adverse effects from fragranced products, this research seeks to understand differences between the general public and vulnerable groups in Germany. The author posits hypotheses about the predominance of dermal effects, the behavior and risk perceptions of fragrance-sensitive individuals, preferences for fragrance-free products, gender and age differences in label-reading, and knowledge regarding natural versus synthetic fragrances and emission of hazardous air pollutants. The purpose is to inform risk assessment and policy by clarifying exposures, health outcomes, knowledge, and behaviors related to fragranced products.

Prior research documents widespread use of fragranced compounds in household and personal care products, with incomplete disclosure of ingredients. Legal frameworks in the EU restrict or require labeling for a subset of allergenic fragrance ingredients in cosmetics (e.g., 26 allergens), yet many other fragrance chemicals are hazardous (e.g., respiratory irritants) and used across diverse product categories. Representative surveys in the USA, Australia, UK, and Sweden reported that approximately one-third of respondents experienced adverse health effects from fragranced products. In Germany, earlier work has focused predominantly on dermal sensitization and contact allergy, often in dermatology patient populations and with emphasis on the 26 labelable allergens, potentially neglecting other health outcomes (respiratory, mucosal, neurological) and product categories. Studies also highlight that fragranced products emit hazardous air pollutants, disclosure on labels is limited, and that 'natural/green/organic' products can emit similar hazardous pollutants. Risk communication efforts and consumer knowledge about chemicals are generally limited.

Design: Cross-sectional online survey of adults (18–65) in Germany, conducted March 2019. Sampling: Nationally representative random sample by age, gender, and region (n=1102; 95% confidence, ±3% margin of error). Administration: German language; implemented by Survey Sampling International (SSI, now Dynata). Completion rate: 83%. Anonymity assured. Measures: Questions covered fragranced product use and exposure; health effects associated with exposures; specific exposure situations; workplace and societal effects; preferences for fragrance-free environments and policies; demographics. New items included attitudes toward attractiveness from perfume use, perceived hygiene, laundry scent preference, label-reading for fragrance information, influence of ingredient information on purchases, beliefs about natural vs. synthetic fragrance healthfulness, and preferences for fragrance-free products. Operational definitions: Fragrance-sensitive persons reported one or more adverse health effects from exposure to fragranced products. Autists were those reporting a clinician diagnosis of autism or autism spectrum disorder. Asthmatics reported a clinician diagnosis of asthma or asthma-like condition. Subgroups were defined by 'yes' responses to specific survey items (e.g., preferring fragrance-free products, reading references/labels). Analysis: Descriptive statistics summarizing proportions in the general population and subgroups; acknowledgment that subgroups overlap. Ethics: Approved by the University of Melbourne. Data were self-reported and anonymous.

Sample and exposure: • 96.9% of the general population reported exposure to fragrances from their own use at least weekly; 82.1% reported exposure from others’ use. • Main sources: personal care products (own use 89.9%); others’ perfumes (65.1%). • Fragrance-sensitive individuals reported even higher exposure: own use 98.6%; others’ use 94.5%. • 72.5% use perfumed products to feel more attractive; among those, 7.6% report respiratory problems upon exposure. Health effects overall and by subgroup: • 19.9% of the population are fragrance-sensitive. • In the general population, most frequently reported effects: respiratory problems (11.0%), mucosal problems (7.1%), skin problems (6.4%), neurological problems (5.4%), migraine headaches (5.0%), gastrointestinal problems (4.4%), cognitive problems (3.7%), asthma attacks (3.4%), cardiovascular problems (2.9%), immune problems (2.6%), musculoskeletal problems (1.9%). • Among fragrance-sensitive persons: respiratory 55.3%, mucosal 35.6%, skin 32.0%, neurological 27.4%, migraine 25.1%, GI 21.9%, cognitive 18.7%, asthma attacks 16.9%, cardiovascular 14.6%, immune 13.2%, musculoskeletal 9.6%. • Autists reported high rates: fragrance-sensitive 81.6%, asthma 79.6%, immune system problems 38.8%, respiratory 30.6%, mucosal 28.6%, skin 34.7%, neurological 30.6%; 57.1% reported total or partial loss of bodily or mental function due to fragrance exposure; 53.1% multiple chemical sensitivities. • Nearly half (45.2%) of fragrance-sensitive persons reported diagnosed asthma. Situational triggers (general population vs. subgroups): • Health problems when in a room cleaned with scented products: 11.9% general; 59.8% fragrance-sensitive; 57.1% autists. • Near someone wearing fragranced product: 10.2% general; 51.1% fragrance-sensitive; 55.1% autists. • Air fresheners/deodorizers: 9.4% general; 47.5% fragrance-sensitive; 44.9% autists. • Laundry dryer vent: 6.8% general; 34.2% fragrance-sensitive; 57.1% autists. • Work exposure causing sickness/work impacts: 5.5% general; 22.4% fragrance-sensitive; 44.9% autists. Knowledge and attitudes: • Awareness that fragrances are mixtures of dozens–hundreds of chemicals: 40.2% general; higher in readers of references (53.2%) and autists (67.3%). • Awareness that fragrance chemicals need not be fully disclosed on labels/MSDS: 27.5% general; 42.3% among reference readers. • Awareness that fragranced products emit hazardous air pollutants (HAPs) such as formaldehyde: 23.9% general; 38.5% reference readers; 61.2% autists. • Awareness that natural/green/organic fragranced products can emit HAPs: 14.2% general; 26.6% reference readers; 42.9% autists. • Belief that products with natural fragrance ingredients are healthier than synthetic: 55.6% general; higher across all subgroups (up to 100% among those who consider natural healthier). Behaviors: • 28.3% read product references/labels for fragrance information; more men, especially ages 18–24, report label reading. • People preferring fragrance-free products still report high self-exposure and health effects; exposure reduction behaviors were not evident across sensitive groups. Overall patterns: • Predominant reported effects are respiratory and mucosal, not dermal. • Subgroups (asthmatics, autists, fragrance-sensitive) report substantially higher adverse effects than the general population.

Findings counter several initial hypotheses. Contrary to expectations rooted in prior German research focusing on dermal allergy, inhalation-related effects (respiratory and mucosal) predominate in both the general population and subgroups, indicating that risk assessments limited to dermal endpoints and the 26 labelable allergens are insufficient. Despite recognizing adverse effects, fragrance-sensitive and other vulnerable individuals report exposure levels from their own and others’ use similar to or greater than the general population, and many do not engage in risk-reducing behaviors (e.g., preferring fragrance-free products, reading labels). This apparent cognitive dissonance may stem from cultural habits, social norms, or trade-offs favoring perceived benefits (e.g., attractiveness) over health concerns. Knowledge gaps are substantial: fewer than half understand the chemical complexity of fragrances, and very few know that both conventional and natural/green fragranced products can emit hazardous air pollutants. Misbeliefs that 'natural' equals 'healthier' are widespread, even among people who read labels or prefer fragrance-free products. The results suggest that current risk communication strategies and labeling provisions do not effectively motivate exposure reduction, especially among vulnerable groups. Broader consideration of non-dermal outcomes, multiple product categories, and aggregate indoor exposures is needed to align risk assessment and regulation with reported experiences.

A nationally representative German survey shows that adverse health effects linked to fragranced consumer products are common, with respiratory and mucosal problems most frequently reported, especially among vulnerable groups such as asthmatics, autists, and fragrance-sensitive individuals. Self-reported exposures are ubiquitous and high, even among those acknowledging adverse effects or preferring fragrance-free options, suggesting a disconnect between risk perception and behavior. Current labeling and risk communication focusing primarily on dermal effects and limited ingredient disclosure appear inadequate for reducing exposures or informing consumers. The study highlights the need to expand safety assessments to include aggregate exposures and a broader spectrum of health endpoints across product categories. Future work should elucidate causal agents and dose–response relationships, enhance disclosure and regulatory measures grounded in the precautionary principle, support clinical identification of fragrance-related illnesses, improve risk communication, explore cultural determinants of fragrance use, and increase availability of fragrance-free products and environments.

Key limitations include: (a) Not all product types or health effects could be listed, though low 'other' responses suggest coverage of main items; (b) Long-term, sub-chronic, indirect, and unconscious effects could not be captured by self-report; (c) Data are self-reported, which may introduce recall or attribution bias; (d) Cross-sectional design limits temporal inference and trend analysis; (e) Adults aged 18–65 only—children and the elderly were excluded; (f) No quantitative data on amounts used, frequencies, or environmental concentrations, limiting exposure quantification; (g) Non-conscious health effects of scent were not assessed; (h) Survey focus on fragrances and detailed effect lists might bias participants to attribute effects to fragrances; (i) Olfactory adaptation may reduce odor perception, leading some affected individuals to under-recognize fragrance-related causes.