Patch Testing to Carvone: North American Contact Dermatitis Group Experience, 2009 to 2018

Abstract

Background/Objectives: Carvone, a flavoring agent, may cause allergic contact dermatitis. This study summarizes patch test reactions to carvone in patients tested by the North American Contact Dermatitis Group, 2009 to 2018.Methods: This was a retrospective analysis of patients positive to carvone (5% petrolatum). Demographics were compared with those of patients who were negative. Other analyses included reaction strength, clinical relevance, coreactivity with other fragrance/flavor allergens, and exposure sources.Results: Of 24,124 patients tested to carvone, 188 (0.78%) were positive. As compared with carvone-negative patients, carvone-positive patients were significantly more likely older than 40 years (P = 0.0284). Women (76.1%) and/or facial involvement (33.0%) were common in the carvone-positive group but not statistically different from carvone-negative patients; 73.3% (n = 138) of the reactions were currently relevant. Relevant sources were personal care products (46.3%, n = 87) and food (14.3%, n = 27). Coreactivity with other fragrance/flavor markers was present in 60.6% of carvone-positive patients, most commonly fragrance mix I (34.6%), balsam of Peru (24.5%), and cinnamic aldehyde (15.4%).Conclusions: Ten-year prevalence of carvone sensitivity was 0.78%. Most carvone-positive patients were female, were older than 40 years, and/or had facial dermatitis. Personal care products were the most common source. Two-fifths of carvone reactions would have been missed by relying on other fragrance/flavoring allergens.

The use of carvone in consecutive patch testing

“…As carvone and limonene are chemically related, an association between carvone and oxidised limonene would not be surprising. However, in previous studies, only a small number of patients sensitised to carvone also reacted to oxidised limonene, 13 , 15 and in the present study only a weak association between hydroperoxides of limonene and carvone was found. Furthermore, a significant part of the carvone‐positive patients (64%) did not have a concomitant allergy to a fragrance/flavour substance, and 44% of those with a clinically relevant carvone allergy would have been missed if not tested with carvone.…”

“…In an earlier study, concomitant allergy to sesquiterpene lactone mix was common, 8 , 14 but in our study and in the recent North American study, this was uncommon. 13 …”

Orofacial Granulomatosis Due to Carvone Allergy in a Pediatric Patient

“…Several cases of cheilitis and lichen planus from carvone in toothpaste have been described 1,4 . Only 1 case of carvone-associated orofacial granulomatosis has been reported.…”

Bioactive properties of the aromatic molecules of spearmint (Mentha spicataL.) essential oil: a review

“…Women (76.1%) were common in the carvone-positive group. 148 Quertermous and Fowler also described that a woman used a hair conditioner with a mint scent, and the dermatitis resolved when she stopped using this product. 149…”