What Is Cosmetic Allergy?

Introduction 

Definition and scope of cosmetic allergy

A cosmetic allergy may be defined as an exaggerated immune response towards a stimulus (in this case, an ingredient in the cosmetic item) that typically has no harmful effect on most people.¹ 

In some cases, the allergic reaction does not occur on the first application or use of a product. Instead, the allergy forms over time as you become exposed to the allergen, and you may find that a product that you experience an allergic reaction to is a product you have been using for quite some time.

Cosmetic allergy vs. irritation

Skin irritation differs from an allergic reaction in that it is not caused by an immune response. Skin irritation may be caused by overuse or repeated exposure to a harsh chemical. While an allergic reaction may have symptoms that affect different regions of the body, skin irritation is limited to the area where the product is applied.

Common cosmetic allergens

There are a few different types of allergens in cosmetics. The most common include:

• Fragrances - such as esters and alcohols²
• Dyes  - may be listed in the ingredients as p-phenylenediamine (PPD) or coal tar)²
• Preservatives - may be listed as methylisothiazolinone (MIT), methylchloroisothiazolinone (CMIT), or formaldehyde, among others²
• Natural rubber - such as latex)²
• Metals - this could include nickel or gold among others)²

However, this is not an exhaustive list and other ingredients may cause allergic reactions.

Symptoms of cosmetic allergy

Skin reactions

An allergic reaction to an ingredient in a cosmetic is caused by the body’s immune system falsely recognising it as harmful and reacting as such. This can lead to several different symptoms with varying degrees of severity. 

Some of the most common symptoms displayed in the case of an allergic reaction would be the skin becoming red, itchy, and flaky in the area where the cosmetic product was applied. The skin may also start to peel and become very dry.² 

A more serious reaction can result in hives, a condition where an itchy rash with raised bumps forms on the skin. The affected area may also have a burning or stinging sensation. On lighter skin, the rash may appear pink on the skin and darker skin it may show up as slightly lighter raised patches but may also be harder to see. Hives can go away on their own, but when caused by an allergic reaction, they can be treated with antihistamines, steroid tablets, or menthol cream, all of which can be obtained either by consulting a pharmacist or prescribed by a GP. It is important to seek treatment if the hives last longer than two days if the rash is spreading or keeps coming back, or if you have a high temperature.³

Eye and respiratory symptoms

When the allergic reaction is caused by an ingredient in a product such as perfume, the inhaled vapours may cause a reaction that affects the respiratory system or eyes. This may be more common among people with conditions such as asthma that affect the respiratory system. The affected individual would typically experience shortness of breath, coughing and wheezing, chest tightness, and the sensation of suffocation. 

If an individual has hives due to an allergic reaction, they may also experience angioedema- the sudden swelling of the body (usually the face or hands and feet, but it can also cause the throat to swell up, leading to breathing difficulties).⁴

Anaphylactic reactions

Anaphylaxis is a very severe reaction to an allergen that requires urgent treatment as it is potentially life-threatening. It can occur within minutes of coming into contact with the allergen. Symptoms include:

• Difficulty breathing and swelling of both the throat and tongue.
• Wheezing and coughing.
• Feelings of tiredness, confusion, dizziness, and fainting.
• Skin feels cold to the touch and appears pale, blue, or grey.

If the person affected carries an EpiPen (an adrenalin auto-injector used to treat anaphylaxis) with them, follow the instructions on the injector to administer the dose and immediately call emergency services for an ambulance. Anaphylaxis is a medical emergency and needs treatment in the hospital, so do not delay if you think you or someone else is experiencing anaphylaxis.⁵

Diagnosis and allergy testing

Patch testing

If you have experienced an allergic reaction to a cosmetic product in the past, it is important to identify what caused the reaction, as most allergies are lifelong, and some can become more severe with time. 

Patch testing is one of the first ways a doctor may attempt to identify what causes the allergy. This involves putting a small amount of the suspected allergen onto the individual’s skin before covering the area for around 48 hours. The doctor will then inspect the site after 72 to 96 hours for any sign of a reaction (e.g. rash, redness, swelling, or hives.)²

Consultation with allergists and dermatologists

If the patch test was not sufficient to diagnose the allergy or the individual’s skin is too sensitive, then other methods must be used to identify the allergen. This may be carried out by an allergist or dermatologist. 

The other methods include:

• Prick test  - This involves placing the allergen on the skin, then pricking the area with a needle and monitoring the site for a reaction.
• Intradermal test  - This involves injecting the allergen into the top layer of the skin before monitoring for any reaction.
• Allergy blood test  - Taking a blood sample and adding the allergen to see if any antibodies form in response to the allergen, which would indicate an allergy.²

Identifying the culprit cosmetic product

It is important to identify the allergen in the cosmetic product as it may be widely used in other products, too, causing the individual to come into frequent contact with the allergen. This may be dangerous as some allergies become very severe with repeated exposure.

Preventing cosmetic allergies

Reading product labels and ingredient lists

If you have been able to identify what ingredient causes your allergic reaction, then you need to avoid the allergen in the future. This can be done by carefully reading the ingredient list before you buy a product. If the packaging simply states the generic terms such as ‘fragrance’ or ‘dye’, then it may be a good idea to use the contact information provided on the packaging to clarify if the product contains the allergen.

Hypoallergenic and fragrance-free options

Some cosmetic products on the market are labelled as ‘hypoallergenic’ or ‘fragrance-free’, but that alone is not enough to guarantee that they will not cause an allergic reaction. It is still a good idea to check the ingredients and clarify with the manufacturer if you are unsure about the ingredients before you use or purchase the product. 

The regulations governing the use of the terms ‘hypoallergenic’ and ‘fragrance-free’ differ depending on where in the world the product is from and where it is sold. In the United States, the Food and Drug Administration (FDA) does not have a set definition or guidelines for using either term and recommends that the individual check the ingredients before using a product.² In the European Union, the regulations are stricter, and any claims regarding the ingredients or properties of a product must be truthful, but there is also the acknowledgement that while the number of potential allergens in a product may be low, it is still not completely free from risk.

Cross-referencing known allergens

In some cases where an individual is allergic to one specific allergen, they may find themselves allergic to similar substances. For example, an allergy to one ester may indicate a potential allergy to other fragrances in cosmetic products. So, care must be taken before trying new products with known allergens in the ingredients.

Managing cosmetic allergies

Treatment of mild to moderate reactions

Some allergic reactions are mild enough that they go away on their own, but more serious reactions may require treatment with steroids (topical creams or tablets) or antihistamines.

Severe allergic reactions and emergency measures

Severe allergic reactions require urgent treatment in the hospital by medical professionals. If an individual has a known allergy, then an EpiPen (an adrenalin auto-injector used to treat anaphylaxis) may be administered. You would also need to call emergency services (999 for the UK, 911 for the United States, and 112 in the European Union) immediately and let them know the individual has had a severe allergic reaction.

Avoidance strategies

One way to avoid a more serious reaction to a new cosmetic product is to do a patch test before using it for the first time. This involves putting a small amount of the product on the skin near the area of intended use (you can test a face product on the near or a hair dye behind your ear, or a new product may be tested on your forearm) and waiting for 48 hours in case of an allergic reaction. By using a small amount first, you can establish if a product is safe to use and whether it would cause an allergic reaction.

Cosmetic allergy in special populations

Care must be taken when an individual already has pre-existing skin conditions like eczema, as their skin may be more sensitive towards common allergens. It is strongly recommended to do a patch test with new products or to consult a dermatologist if you are unsure or concerned about the effect on your skin before using new products.

Cosmetic allergy trends and research

Research is being carried out to understand what types of ingredients cause allergic reactions in the body. There are an increasing number of products available on the market that do not contain certain allergens and offer alternative products to those who suffer from allergies. For example, some cosmetic and skincare brands offer a specific range that caters to those with sensitive skin, and these products contain minimal ingredients (including fewer potential allergens) to allow more accessibility. 

There are also alternative products, such as mineral sunscreen instead of chemical sunscreen, for those who still want to use sunscreen but find that they cannot due to the ingredients used in other sunscreens on the market.

Summary

A cosmetic allergy is an exaggerated immune response towards an ingredient in a cosmetic product that typically has no harmful effect on most people.  Cosmetic allergies can be caused by a variety of different ingredients, such as fragrances, dyes, and preservatives. It is important to diagnose what the allergy was caused by and whether it is possible to avoid that particular ingredient. Patch testing is a common approach to identifying the cause of the allergy.  Depending on the severity of the reaction, there are different treatment options available to help manage the symptoms of the allergic reaction, including steroids and antihistamines for mild to moderate reactions and adrenaline autoinjector pens (e.g. EpiPen) for severe allergic reactions. However, prevention is better than cure. It is also important for the individual to pay attention to the ingredients before purchasing a new cosmetic product.  There are often alternative products available for those who are allergic to many common allergens.