In 1997 the Federal Drug Administration gave indication to the Thin-layer Rapid Use Epicutaneous (T.R.U.E.) Test for use as a valuable, first-line screening tool in the diagnosis of allergic contact dermatitis (ACD). Many dermatologists and allergists use this standard tool in their practices and refer to contact dermatitis referral centers when the T.R.U.E test fails to identify a relevant allergen. Specifically, the T.R.U.E. test screens for 46 distinct allergens in addition to the balsam of Peru mixture and is thought to adequately identify an allergen in approximately 24.5% of patients.1
This being said, many relevant allergens are not detected by use of this screening tool alone and, for this reason, Allergen Focus has been expanded to cover the notorious Allergens of the Year and other top relevant allergens identified by the North American Contact Dermatitis Group.
This month we focus on jasmine absolute, an ingredient commonly used in perfumes.
Contact Dermatides
The contact dermatides include ACD, irritant contact dermatitis (ICD), and contact urticaria (CU).
The most common form, ICD, accounts for approximately 80% of environmental-occupational-based dermatoses.
Contact urticaria (wheal and flare reaction) represents an IgE and mast cell-mediated immediate-type hypersensitivity reaction that can lead to anaphylaxis. The foremost example of this would be latex protein hypersensitivity. While this is beyond the scope of this section, we acknowledge this form of hypersensitivity due to the severity of the potential reactions and direct the reader to key resources.2, 3
Allergic contact dermatitis is a T-cell-dependent, delayed-type (Type IV) hypersensitivity reaction that has a high impact both in terms of patient morbidity and economics. This type of hypersensitivity reaction is primarily instigated by small lipophilic chemicals (haptens) with a molecular weight less than 500 Daltons. These chemical allergens trigger a complex immunologic cascade in the skin that leads to the clinical picture of ACD.
Case Illustration
A patient presented to the University of Miami Allergic Contact Dermatitis Clinic for evaluation of a dermatitis primarily involving her face and neck. She had been evaluated with the T.R.U.E. Test, and no positive allergic reactions were found. Of note, she disclosed using a large variety of fine fragrances.
The History of Essential Oils
Essential oils are the highly concentrated, volatile (rapidly evaporating) aromatic substances extracted from various plants and trees. Because these oils were thought to represent the plant’s essence of flavor and odor, they were named essential.4 Throughout the ages these oils have been highly valued for their healing properties and ability to uplift the spirit and body.
Ancient Egyptians were well-versed in the uses of aromatics, on which they left written documentation. For example, an inscription on the tomb of the Egyptian queen Hathsepsut describes the use of frankincense as incense (circa 15th century B.C.).5 Furthermore, the Egyptian papyrus manuscripts discovered in the mid-19th century described more than 6,000 years of aromatic history.6 Remnants of these writings were first unearthed during the excavation of an ancient Greek library at Herculaneum, a city formerly conquered by the Greeks, in present-day Italy.6
Interestingly, these documents literally survived the sands of time because debris from a Mount Vesuvius eruption had encased and preserved the documents stored at Herculaneum. Very few documents, on the other hand, survived the harsh climate in Egypt.
With the exciting new papyrus discoveries, the Egypt Excavation Society formed with the specific purpose of searching Egypt for papyri.6 The successful excavation of the manuscripts from the Temple of Edfu (found at the Valley of Kings), dating back to 4500 B.C., gave new insight into the ancient Egyptian way of life and described the process priests used to formulate medicines, gustatory (taste) enhancers, cosmetic enhancement medicines, perfumes, and how they used them for religious ceremonies.7 These papyri also describe the importation of these scents as tributes from conquered people and as honoraria gifts to the gods.8, 9
The Greeks learned of these aromatic infusions from the Egyptians and valued them as divine gifts. Upon returning home from a visit to the Nile Valley in 500 B.C., the Greeks established a medical school on the island of Cos. Here, Egyptian experience and Greek knowledge were combined to advance the use of aromatic substances.8
Hippocrates: Essential Oils As Part of a Health Regimen
Hippocrates, a fifth century B.C. graduate of this medical school, was the first to recommend daily bathing and massage with essential oils as the basis for a reliable health regimen.
Hippocrates, also known as the Father of Medicine, is credited with contradicting popular belief of the times that diseases were not acts of the gods, but rather physical abnormalities in the bodily “humors” (blood, phlegm, yellow bile, and black bile). Notably, he believed that disease was therefore curable by man.10
During the third century B.C., Hippocrates and his fellowship formed the Corpus Hippocraticum, the original collection of medical writings on which allopathic (Western) medicine is based. These essays contain prescriptions for essential oil remedies and the distinctive Hippocratic Oath, the code of ethical pledges and guidelines new physicians take to this day.11
The Bible also mentions the use of various essential oils, such as frankincense (a.k.a: Olibanum-Boswellia carteri) and myrrh (a.k.a: Commiphora myrrha). These oils, treasured for their healing powers, are believed to be two of the three gifts presented at the birth of Jesus Christ. Of note, frankincense is thought to have held more value than gold, during this time.12
The Romans gained their aromatic knowledge from the Greeks and provided this luxury to their citizens, distributing over 1,000 fragrant watering spots, or bathing areas, around the city. By the year 30 A.D., the tremendous popularity of oils led to supply depletions on ritual alters and a law banning the personal usage of these scents.8 Nonetheless, the popularity of essential oils continued to grow in both medicinal and personal value.
The Black Plague and the Use of Essential Oils
Interestingly, during both the Black Plague (the bubonic plague that killed almost one-third of Europe) of the 14th century, and second Bubonic Plague of the 16th century, aromatics were used to conceal the stench of death and to disinfect the air. As physicians walked the streets, they would wave canes filled with these aromatic substances in front of them, as an added antiseptic measure.8 A common nursery rhyme echoes this practice with “Ring Around the Rosie” referencing the skin buboes of the Bubonic Plaque, and the “Pocket Full of Posies” referring to the flowers carried to inhale their essential oils whose antibacterial properties warded off disease.13
Essential oils were found to not only have antibacterial properties, but also to enhance healing.
In 1937, Reneé-Maurice Gattefossé, a French biochemist, burned his arm in a laboratory explosion in his family’s perfumery business. He quickly plunged his arm into the nearest tub of cold liquid, which as serendipity would have it, turned out to be lavender oilated water.
Not only was the liquid an analgesic, but he also found that it increased the rate at which wounds healed, leading him to hypothesize that essential oils could be used therapeutically. He further postulated that the oils could pass through the skin and exert a holistic effect, and therefore coined his theory “aromatherapie.”8
Noted physician Jean Valnet, having become inspired by childhood recollections and Gattefossé’s work, began using essential oils on burn and wound patients as an army surgeon during WWII.
At the young age of 14, Valnet had witnessed an injured farm worker using a poultice made of spider web and various plants to stop infection and heal the wound. This early experience caused Valnet to pursue doctoring and as a second-year medical student he worked for a professor who taught him the therapeutic properties of plants. After leaving the army in 1959, he devoted his civilian medical practice to the practice and study of natural therapies, something he had become interested in at a very young age.
By 1964, Valnet was successfully treating both psychiatric and medical patients with essential oils. Furthermore, he determined proper dosages of essential oils and earned the title of Father of Modern Aromatherapy. He published his life’s work in Aromatherapie, which established the science of modern aromatherapy.
Since then, Valnet has presided over aromatherapy and herbal medicine congresses, founded the first research society in the field, and, in 1981, founded the French College of Aroma Therapies and Country Medicine, which offers a wide range of educational programs.8,14
Actions of Essential Oils
The Greek word for aroma refers to chemicals that affect the sense of smell through the olfactory system.15 When an essential oil is massaged into the skin, the absorption inhibits bacterial growth, affects hormone levels, and alters the lipid composition of cell membranes.
Beta rhythms of the brain — normal rhythms associated with a wakeful state that are thought to increase mental alertness — are also thought to be affected by essential oils. Notably, the essential oil jasmine is thought to promote these rhythms by activating two chemical opioid receptors, leading to euphoric and aphrodisiac sensations.16, 17
The History of Jasmine Absolute
Jasmine has long been referred to as the king of oils for its heavy aroma and spicy overtones.18 Infused jasmine oil was used by the ancient Egyptians to anoint their bodies, as the ascending vapors were thought to bring a stronger connection to the spiritual world.19
Cleopatra, one of the most famous monarchs of the East during the first century B.C., was well known for her love of fragrances. Legend holds that Cleopatra was not of great beauty, but of immense seductiveness. She used cosmetics and fragrances made of essential oils to place her at an advantage with men. It is believed that Cleopatra had her ship sails and robes infused with perfume, burned incense around her throne, and notably bathed in jasmine essential oil before seducing Mark Anthony, a general in the army of Julius Caesar.20
Jasmine is believed to symbolize divine hope in India, the sweetness of a woman in China, and is admired as “the perfume of love” in Muslim and Hindu traditions. Karma, the Indian god of love, is said to have tipped his arrows with jasmine blossoms in order to pierce the heart through the senses.16
Producing Jasmine Absolute Takes Thousands of Flowers
It should be noted that there are at least 43 different varieties of jasmine, although only two are used in the production of the jasmine absolute essential oil, Jasminum grandiflorum and Jasminum officinale, both natives of Southwest Asia.21 The majority of jasmine absolute is produced in Egypt and India, but France, Italy, Morocco, and Algeria produce smaller quantities.17
Because they are both extremely similar in their chemical constituents, the oils from each flower are used interchangeably in aromatherapy.16 (See Table 1.) A bad growth season of one can be compensated for with the other. This is an especially fortunate fact given that in order to produce 1 gram of jasmine absolute, about 8,000 hand-picked blossoms are needed.17
For the most part, these prized flowers are carefully hand picked as the blossoms are unfolding during the early hours of dawn. Only the fully blossomed flowers are picked and placed into a small hand-held basket with careful attention not to bruise or mishandle the flowers, as this could compromise the aroma.
The French enfleurage solvent extraction method provides the highest yield of jasmine oil, because it allows the flowers to continue to produce their oils after they are picked, providing the same natural scent as if it were still on the bush.
On the other hand, concrete extraction, the most widely-used method, is done in Egypt. Of the world’s supply of jasmine absolute, 70% to 80% is produced by the latter method, even though the absolute scent is not fully retained.17
On the Use of Jasmine
Jasmine is known for its exotic, rich, and relaxing scent.19 Yet, it is also used as a topical balming tonic for irritated skin, eczema, acute dermatitis, neurogenic pruritus, painful injuries, and ulcers.22,16 Jasmine has even been utilized in the treatment of exhaustion and labor pains.22 It is thought to speed the recovery of a woman after childbirth by dismissing postnatal depression, promoting milk flow, and intensely nurturing the woman’s feelings, femininity, and sexuality.16
Jasmine produces its aphrodisiac sensation by eliciting the release of endorphins from the pituitary gland, leading to a sense of euphoria.17 It is not a surprise that as a result of its plethora of positive effects, jasmine is found in numerous fine fragrances (see Table 2).
Allergy to Jasmine Absolute
Allergic reactions Allergic reactions from contact with jasmine essential oil have been reported.22 Jasmine absolute was also found to be one of the causes of pigmented contact dermatitis, a term coined circa 1970, describing the occurrence of gray-brown facial pigmentation in a group of middle-aged women.23
Older individuals, women more commonly than men, are especially prone to developing allergic reactions to jasmine absolute, possibly due to a greater use of fine fragrances containing the oil.24
In 2002, a multi-center study at six dermatologic centers in Europe found that 1.2% of 1,606 subjects who had a history of adverse reactions to scented products reacted to jasmine absolute on a patch test of fragrance material.25 This pivotal study was instrumental to the inclusion of jasmine absolute on the standard comprehensive screening trays.
Adulteration and Contamination
Jasmine absolute is often contaminated with unwanted chemical adulterants during the purification process, such as phthalate — a plastic softener — and ethanol.26
Many of these adulterants are purposefully added in order to drive the price down by including cheaper alternative oils, oil fractions, by-products, fillers, and jasmine synthetics (see Table 3).27
It is noteworthy to mention that 1 pound of pure jasmine absolute can cost more than $1,200, whereas a pound of synthetic jasmine can be produced for as little as $5.28 Unfortunately, it can be difficult to determine if a company is selling pure jasmine oil, if it has been diluted, or if it is synthetic.29
Despite this knowledge, many companies that purchase jasmine oil do not test or look at the major components of jasmine oil.27
Of note, the phthalate ester has been removed from many cosmetic manufacturers’ ingredients list due to potential toxicities in animal studies; hence, jasmine absolute users should be wary of the potential addition of this chemical to the oil.28 Toxicities of the phthalate ester include damage to the liver, kidney, lungs, and developing testes.30
Testing for Jasmine Sensitivity
The standard screening tray of the North American Contact Dermatitis Group (NACDG) contains 65 allergen components. Among these 65 are components specifically selected to identify top fragrance sensitizers and have included jasmine absolute, fragrance mixes 1 and 2, tea tree oil, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, and ylang ylang oil. Notably, testing with fragrance mix 1 alone is thought to identify 85% of fragrance-allergic patients.24 However, with the addition of ylang ylang oil, narcissus oil, and sandalwood oil fragrance components, the ability to detect fragrance allergy may near 95%.24, 31
The Value of This Patient Case
The patient tested positive to jasmine absolute, which demonstrates the importance of appropriate patch testing. Furthermore, with discontinued use of fragrances (a.k.a. avoidance), specifically those containing jasmine, this patient was able to remain dermatitis-free.
Dedication: This column is dedicated to master mentor in contact dermatitis, Dr. James Taylor, for his inspiration and guidance. Thank you.
In 1997 the Federal Drug Administration gave indication to the Thin-layer Rapid Use Epicutaneous (T.R.U.E.) Test for use as a valuable, first-line screening tool in the diagnosis of allergic contact dermatitis (ACD). Many dermatologists and allergists use this standard tool in their practices and refer to contact dermatitis referral centers when the T.R.U.E test fails to identify a relevant allergen. Specifically, the T.R.U.E. test screens for 46 distinct allergens in addition to the balsam of Peru mixture and is thought to adequately identify an allergen in approximately 24.5% of patients.1
This being said, many relevant allergens are not detected by use of this screening tool alone and, for this reason, Allergen Focus has been expanded to cover the notorious Allergens of the Year and other top relevant allergens identified by the North American Contact Dermatitis Group.
This month we focus on jasmine absolute, an ingredient commonly used in perfumes.
Contact Dermatides
The contact dermatides include ACD, irritant contact dermatitis (ICD), and contact urticaria (CU).
The most common form, ICD, accounts for approximately 80% of environmental-occupational-based dermatoses.
Contact urticaria (wheal and flare reaction) represents an IgE and mast cell-mediated immediate-type hypersensitivity reaction that can lead to anaphylaxis. The foremost example of this would be latex protein hypersensitivity. While this is beyond the scope of this section, we acknowledge this form of hypersensitivity due to the severity of the potential reactions and direct the reader to key resources.2, 3
Allergic contact dermatitis is a T-cell-dependent, delayed-type (Type IV) hypersensitivity reaction that has a high impact both in terms of patient morbidity and economics. This type of hypersensitivity reaction is primarily instigated by small lipophilic chemicals (haptens) with a molecular weight less than 500 Daltons. These chemical allergens trigger a complex immunologic cascade in the skin that leads to the clinical picture of ACD.
Case Illustration
A patient presented to the University of Miami Allergic Contact Dermatitis Clinic for evaluation of a dermatitis primarily involving her face and neck. She had been evaluated with the T.R.U.E. Test, and no positive allergic reactions were found. Of note, she disclosed using a large variety of fine fragrances.
The History of Essential Oils
Essential oils are the highly concentrated, volatile (rapidly evaporating) aromatic substances extracted from various plants and trees. Because these oils were thought to represent the plant’s essence of flavor and odor, they were named essential.4 Throughout the ages these oils have been highly valued for their healing properties and ability to uplift the spirit and body.
Ancient Egyptians were well-versed in the uses of aromatics, on which they left written documentation. For example, an inscription on the tomb of the Egyptian queen Hathsepsut describes the use of frankincense as incense (circa 15th century B.C.).5 Furthermore, the Egyptian papyrus manuscripts discovered in the mid-19th century described more than 6,000 years of aromatic history.6 Remnants of these writings were first unearthed during the excavation of an ancient Greek library at Herculaneum, a city formerly conquered by the Greeks, in present-day Italy.6
Interestingly, these documents literally survived the sands of time because debris from a Mount Vesuvius eruption had encased and preserved the documents stored at Herculaneum. Very few documents, on the other hand, survived the harsh climate in Egypt.
With the exciting new papyrus discoveries, the Egypt Excavation Society formed with the specific purpose of searching Egypt for papyri.6 The successful excavation of the manuscripts from the Temple of Edfu (found at the Valley of Kings), dating back to 4500 B.C., gave new insight into the ancient Egyptian way of life and described the process priests used to formulate medicines, gustatory (taste) enhancers, cosmetic enhancement medicines, perfumes, and how they used them for religious ceremonies.7 These papyri also describe the importation of these scents as tributes from conquered people and as honoraria gifts to the gods.8, 9
The Greeks learned of these aromatic infusions from the Egyptians and valued them as divine gifts. Upon returning home from a visit to the Nile Valley in 500 B.C., the Greeks established a medical school on the island of Cos. Here, Egyptian experience and Greek knowledge were combined to advance the use of aromatic substances.8
Hippocrates: Essential Oils As Part of a Health Regimen
Hippocrates, a fifth century B.C. graduate of this medical school, was the first to recommend daily bathing and massage with essential oils as the basis for a reliable health regimen.
Hippocrates, also known as the Father of Medicine, is credited with contradicting popular belief of the times that diseases were not acts of the gods, but rather physical abnormalities in the bodily “humors” (blood, phlegm, yellow bile, and black bile). Notably, he believed that disease was therefore curable by man.10
During the third century B.C., Hippocrates and his fellowship formed the Corpus Hippocraticum, the original collection of medical writings on which allopathic (Western) medicine is based. These essays contain prescriptions for essential oil remedies and the distinctive Hippocratic Oath, the code of ethical pledges and guidelines new physicians take to this day.11
The Bible also mentions the use of various essential oils, such as frankincense (a.k.a: Olibanum-Boswellia carteri) and myrrh (a.k.a: Commiphora myrrha). These oils, treasured for their healing powers, are believed to be two of the three gifts presented at the birth of Jesus Christ. Of note, frankincense is thought to have held more value than gold, during this time.12
The Romans gained their aromatic knowledge from the Greeks and provided this luxury to their citizens, distributing over 1,000 fragrant watering spots, or bathing areas, around the city. By the year 30 A.D., the tremendous popularity of oils led to supply depletions on ritual alters and a law banning the personal usage of these scents.8 Nonetheless, the popularity of essential oils continued to grow in both medicinal and personal value.
The Black Plague and the Use of Essential Oils
Interestingly, during both the Black Plague (the bubonic plague that killed almost one-third of Europe) of the 14th century, and second Bubonic Plague of the 16th century, aromatics were used to conceal the stench of death and to disinfect the air. As physicians walked the streets, they would wave canes filled with these aromatic substances in front of them, as an added antiseptic measure.8 A common nursery rhyme echoes this practice with “Ring Around the Rosie” referencing the skin buboes of the Bubonic Plaque, and the “Pocket Full of Posies” referring to the flowers carried to inhale their essential oils whose antibacterial properties warded off disease.13
Essential oils were found to not only have antibacterial properties, but also to enhance healing.
In 1937, Reneé-Maurice Gattefossé, a French biochemist, burned his arm in a laboratory explosion in his family’s perfumery business. He quickly plunged his arm into the nearest tub of cold liquid, which as serendipity would have it, turned out to be lavender oilated water.
Not only was the liquid an analgesic, but he also found that it increased the rate at which wounds healed, leading him to hypothesize that essential oils could be used therapeutically. He further postulated that the oils could pass through the skin and exert a holistic effect, and therefore coined his theory “aromatherapie.”8
Noted physician Jean Valnet, having become inspired by childhood recollections and Gattefossé’s work, began using essential oils on burn and wound patients as an army surgeon during WWII.
At the young age of 14, Valnet had witnessed an injured farm worker using a poultice made of spider web and various plants to stop infection and heal the wound. This early experience caused Valnet to pursue doctoring and as a second-year medical student he worked for a professor who taught him the therapeutic properties of plants. After leaving the army in 1959, he devoted his civilian medical practice to the practice and study of natural therapies, something he had become interested in at a very young age.
By 1964, Valnet was successfully treating both psychiatric and medical patients with essential oils. Furthermore, he determined proper dosages of essential oils and earned the title of Father of Modern Aromatherapy. He published his life’s work in Aromatherapie, which established the science of modern aromatherapy.
Since then, Valnet has presided over aromatherapy and herbal medicine congresses, founded the first research society in the field, and, in 1981, founded the French College of Aroma Therapies and Country Medicine, which offers a wide range of educational programs.8,14
Actions of Essential Oils
The Greek word for aroma refers to chemicals that affect the sense of smell through the olfactory system.15 When an essential oil is massaged into the skin, the absorption inhibits bacterial growth, affects hormone levels, and alters the lipid composition of cell membranes.
Beta rhythms of the brain — normal rhythms associated with a wakeful state that are thought to increase mental alertness — are also thought to be affected by essential oils. Notably, the essential oil jasmine is thought to promote these rhythms by activating two chemical opioid receptors, leading to euphoric and aphrodisiac sensations.16, 17
The History of Jasmine Absolute
Jasmine has long been referred to as the king of oils for its heavy aroma and spicy overtones.18 Infused jasmine oil was used by the ancient Egyptians to anoint their bodies, as the ascending vapors were thought to bring a stronger connection to the spiritual world.19
Cleopatra, one of the most famous monarchs of the East during the first century B.C., was well known for her love of fragrances. Legend holds that Cleopatra was not of great beauty, but of immense seductiveness. She used cosmetics and fragrances made of essential oils to place her at an advantage with men. It is believed that Cleopatra had her ship sails and robes infused with perfume, burned incense around her throne, and notably bathed in jasmine essential oil before seducing Mark Anthony, a general in the army of Julius Caesar.20
Jasmine is believed to symbolize divine hope in India, the sweetness of a woman in China, and is admired as “the perfume of love” in Muslim and Hindu traditions. Karma, the Indian god of love, is said to have tipped his arrows with jasmine blossoms in order to pierce the heart through the senses.16
Producing Jasmine Absolute Takes Thousands of Flowers
It should be noted that there are at least 43 different varieties of jasmine, although only two are used in the production of the jasmine absolute essential oil, Jasminum grandiflorum and Jasminum officinale, both natives of Southwest Asia.21 The majority of jasmine absolute is produced in Egypt and India, but France, Italy, Morocco, and Algeria produce smaller quantities.17
Because they are both extremely similar in their chemical constituents, the oils from each flower are used interchangeably in aromatherapy.16 (See Table 1.) A bad growth season of one can be compensated for with the other. This is an especially fortunate fact given that in order to produce 1 gram of jasmine absolute, about 8,000 hand-picked blossoms are needed.17
For the most part, these prized flowers are carefully hand picked as the blossoms are unfolding during the early hours of dawn. Only the fully blossomed flowers are picked and placed into a small hand-held basket with careful attention not to bruise or mishandle the flowers, as this could compromise the aroma.
The French enfleurage solvent extraction method provides the highest yield of jasmine oil, because it allows the flowers to continue to produce their oils after they are picked, providing the same natural scent as if it were still on the bush.
On the other hand, concrete extraction, the most widely-used method, is done in Egypt. Of the world’s supply of jasmine absolute, 70% to 80% is produced by the latter method, even though the absolute scent is not fully retained.17
On the Use of Jasmine
Jasmine is known for its exotic, rich, and relaxing scent.19 Yet, it is also used as a topical balming tonic for irritated skin, eczema, acute dermatitis, neurogenic pruritus, painful injuries, and ulcers.22,16 Jasmine has even been utilized in the treatment of exhaustion and labor pains.22 It is thought to speed the recovery of a woman after childbirth by dismissing postnatal depression, promoting milk flow, and intensely nurturing the woman’s feelings, femininity, and sexuality.16
Jasmine produces its aphrodisiac sensation by eliciting the release of endorphins from the pituitary gland, leading to a sense of euphoria.17 It is not a surprise that as a result of its plethora of positive effects, jasmine is found in numerous fine fragrances (see Table 2).
Allergy to Jasmine Absolute
Allergic reactions Allergic reactions from contact with jasmine essential oil have been reported.22 Jasmine absolute was also found to be one of the causes of pigmented contact dermatitis, a term coined circa 1970, describing the occurrence of gray-brown facial pigmentation in a group of middle-aged women.23
Older individuals, women more commonly than men, are especially prone to developing allergic reactions to jasmine absolute, possibly due to a greater use of fine fragrances containing the oil.24
In 2002, a multi-center study at six dermatologic centers in Europe found that 1.2% of 1,606 subjects who had a history of adverse reactions to scented products reacted to jasmine absolute on a patch test of fragrance material.25 This pivotal study was instrumental to the inclusion of jasmine absolute on the standard comprehensive screening trays.
Adulteration and Contamination
Jasmine absolute is often contaminated with unwanted chemical adulterants during the purification process, such as phthalate — a plastic softener — and ethanol.26
Many of these adulterants are purposefully added in order to drive the price down by including cheaper alternative oils, oil fractions, by-products, fillers, and jasmine synthetics (see Table 3).27
It is noteworthy to mention that 1 pound of pure jasmine absolute can cost more than $1,200, whereas a pound of synthetic jasmine can be produced for as little as $5.28 Unfortunately, it can be difficult to determine if a company is selling pure jasmine oil, if it has been diluted, or if it is synthetic.29
Despite this knowledge, many companies that purchase jasmine oil do not test or look at the major components of jasmine oil.27
Of note, the phthalate ester has been removed from many cosmetic manufacturers’ ingredients list due to potential toxicities in animal studies; hence, jasmine absolute users should be wary of the potential addition of this chemical to the oil.28 Toxicities of the phthalate ester include damage to the liver, kidney, lungs, and developing testes.30
Testing for Jasmine Sensitivity
The standard screening tray of the North American Contact Dermatitis Group (NACDG) contains 65 allergen components. Among these 65 are components specifically selected to identify top fragrance sensitizers and have included jasmine absolute, fragrance mixes 1 and 2, tea tree oil, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, and ylang ylang oil. Notably, testing with fragrance mix 1 alone is thought to identify 85% of fragrance-allergic patients.24 However, with the addition of ylang ylang oil, narcissus oil, and sandalwood oil fragrance components, the ability to detect fragrance allergy may near 95%.24, 31
The Value of This Patient Case
The patient tested positive to jasmine absolute, which demonstrates the importance of appropriate patch testing. Furthermore, with discontinued use of fragrances (a.k.a. avoidance), specifically those containing jasmine, this patient was able to remain dermatitis-free.
Dedication: This column is dedicated to master mentor in contact dermatitis, Dr. James Taylor, for his inspiration and guidance. Thank you.
In 1997 the Federal Drug Administration gave indication to the Thin-layer Rapid Use Epicutaneous (T.R.U.E.) Test for use as a valuable, first-line screening tool in the diagnosis of allergic contact dermatitis (ACD). Many dermatologists and allergists use this standard tool in their practices and refer to contact dermatitis referral centers when the T.R.U.E test fails to identify a relevant allergen. Specifically, the T.R.U.E. test screens for 46 distinct allergens in addition to the balsam of Peru mixture and is thought to adequately identify an allergen in approximately 24.5% of patients.1
This being said, many relevant allergens are not detected by use of this screening tool alone and, for this reason, Allergen Focus has been expanded to cover the notorious Allergens of the Year and other top relevant allergens identified by the North American Contact Dermatitis Group.
This month we focus on jasmine absolute, an ingredient commonly used in perfumes.
Contact Dermatides
The contact dermatides include ACD, irritant contact dermatitis (ICD), and contact urticaria (CU).
The most common form, ICD, accounts for approximately 80% of environmental-occupational-based dermatoses.
Contact urticaria (wheal and flare reaction) represents an IgE and mast cell-mediated immediate-type hypersensitivity reaction that can lead to anaphylaxis. The foremost example of this would be latex protein hypersensitivity. While this is beyond the scope of this section, we acknowledge this form of hypersensitivity due to the severity of the potential reactions and direct the reader to key resources.2, 3
Allergic contact dermatitis is a T-cell-dependent, delayed-type (Type IV) hypersensitivity reaction that has a high impact both in terms of patient morbidity and economics. This type of hypersensitivity reaction is primarily instigated by small lipophilic chemicals (haptens) with a molecular weight less than 500 Daltons. These chemical allergens trigger a complex immunologic cascade in the skin that leads to the clinical picture of ACD.
Case Illustration
A patient presented to the University of Miami Allergic Contact Dermatitis Clinic for evaluation of a dermatitis primarily involving her face and neck. She had been evaluated with the T.R.U.E. Test, and no positive allergic reactions were found. Of note, she disclosed using a large variety of fine fragrances.
The History of Essential Oils
Essential oils are the highly concentrated, volatile (rapidly evaporating) aromatic substances extracted from various plants and trees. Because these oils were thought to represent the plant’s essence of flavor and odor, they were named essential.4 Throughout the ages these oils have been highly valued for their healing properties and ability to uplift the spirit and body.
Ancient Egyptians were well-versed in the uses of aromatics, on which they left written documentation. For example, an inscription on the tomb of the Egyptian queen Hathsepsut describes the use of frankincense as incense (circa 15th century B.C.).5 Furthermore, the Egyptian papyrus manuscripts discovered in the mid-19th century described more than 6,000 years of aromatic history.6 Remnants of these writings were first unearthed during the excavation of an ancient Greek library at Herculaneum, a city formerly conquered by the Greeks, in present-day Italy.6
Interestingly, these documents literally survived the sands of time because debris from a Mount Vesuvius eruption had encased and preserved the documents stored at Herculaneum. Very few documents, on the other hand, survived the harsh climate in Egypt.
With the exciting new papyrus discoveries, the Egypt Excavation Society formed with the specific purpose of searching Egypt for papyri.6 The successful excavation of the manuscripts from the Temple of Edfu (found at the Valley of Kings), dating back to 4500 B.C., gave new insight into the ancient Egyptian way of life and described the process priests used to formulate medicines, gustatory (taste) enhancers, cosmetic enhancement medicines, perfumes, and how they used them for religious ceremonies.7 These papyri also describe the importation of these scents as tributes from conquered people and as honoraria gifts to the gods.8, 9
The Greeks learned of these aromatic infusions from the Egyptians and valued them as divine gifts. Upon returning home from a visit to the Nile Valley in 500 B.C., the Greeks established a medical school on the island of Cos. Here, Egyptian experience and Greek knowledge were combined to advance the use of aromatic substances.8
Hippocrates: Essential Oils As Part of a Health Regimen
Hippocrates, a fifth century B.C. graduate of this medical school, was the first to recommend daily bathing and massage with essential oils as the basis for a reliable health regimen.
Hippocrates, also known as the Father of Medicine, is credited with contradicting popular belief of the times that diseases were not acts of the gods, but rather physical abnormalities in the bodily “humors” (blood, phlegm, yellow bile, and black bile). Notably, he believed that disease was therefore curable by man.10
During the third century B.C., Hippocrates and his fellowship formed the Corpus Hippocraticum, the original collection of medical writings on which allopathic (Western) medicine is based. These essays contain prescriptions for essential oil remedies and the distinctive Hippocratic Oath, the code of ethical pledges and guidelines new physicians take to this day.11
The Bible also mentions the use of various essential oils, such as frankincense (a.k.a: Olibanum-Boswellia carteri) and myrrh (a.k.a: Commiphora myrrha). These oils, treasured for their healing powers, are believed to be two of the three gifts presented at the birth of Jesus Christ. Of note, frankincense is thought to have held more value than gold, during this time.12
The Romans gained their aromatic knowledge from the Greeks and provided this luxury to their citizens, distributing over 1,000 fragrant watering spots, or bathing areas, around the city. By the year 30 A.D., the tremendous popularity of oils led to supply depletions on ritual alters and a law banning the personal usage of these scents.8 Nonetheless, the popularity of essential oils continued to grow in both medicinal and personal value.
The Black Plague and the Use of Essential Oils
Interestingly, during both the Black Plague (the bubonic plague that killed almost one-third of Europe) of the 14th century, and second Bubonic Plague of the 16th century, aromatics were used to conceal the stench of death and to disinfect the air. As physicians walked the streets, they would wave canes filled with these aromatic substances in front of them, as an added antiseptic measure.8 A common nursery rhyme echoes this practice with “Ring Around the Rosie” referencing the skin buboes of the Bubonic Plaque, and the “Pocket Full of Posies” referring to the flowers carried to inhale their essential oils whose antibacterial properties warded off disease.13
Essential oils were found to not only have antibacterial properties, but also to enhance healing.
In 1937, Reneé-Maurice Gattefossé, a French biochemist, burned his arm in a laboratory explosion in his family’s perfumery business. He quickly plunged his arm into the nearest tub of cold liquid, which as serendipity would have it, turned out to be lavender oilated water.
Not only was the liquid an analgesic, but he also found that it increased the rate at which wounds healed, leading him to hypothesize that essential oils could be used therapeutically. He further postulated that the oils could pass through the skin and exert a holistic effect, and therefore coined his theory “aromatherapie.”8
Noted physician Jean Valnet, having become inspired by childhood recollections and Gattefossé’s work, began using essential oils on burn and wound patients as an army surgeon during WWII.
At the young age of 14, Valnet had witnessed an injured farm worker using a poultice made of spider web and various plants to stop infection and heal the wound. This early experience caused Valnet to pursue doctoring and as a second-year medical student he worked for a professor who taught him the therapeutic properties of plants. After leaving the army in 1959, he devoted his civilian medical practice to the practice and study of natural therapies, something he had become interested in at a very young age.
By 1964, Valnet was successfully treating both psychiatric and medical patients with essential oils. Furthermore, he determined proper dosages of essential oils and earned the title of Father of Modern Aromatherapy. He published his life’s work in Aromatherapie, which established the science of modern aromatherapy.
Since then, Valnet has presided over aromatherapy and herbal medicine congresses, founded the first research society in the field, and, in 1981, founded the French College of Aroma Therapies and Country Medicine, which offers a wide range of educational programs.8,14
Actions of Essential Oils
The Greek word for aroma refers to chemicals that affect the sense of smell through the olfactory system.15 When an essential oil is massaged into the skin, the absorption inhibits bacterial growth, affects hormone levels, and alters the lipid composition of cell membranes.
Beta rhythms of the brain — normal rhythms associated with a wakeful state that are thought to increase mental alertness — are also thought to be affected by essential oils. Notably, the essential oil jasmine is thought to promote these rhythms by activating two chemical opioid receptors, leading to euphoric and aphrodisiac sensations.16, 17
The History of Jasmine Absolute
Jasmine has long been referred to as the king of oils for its heavy aroma and spicy overtones.18 Infused jasmine oil was used by the ancient Egyptians to anoint their bodies, as the ascending vapors were thought to bring a stronger connection to the spiritual world.19
Cleopatra, one of the most famous monarchs of the East during the first century B.C., was well known for her love of fragrances. Legend holds that Cleopatra was not of great beauty, but of immense seductiveness. She used cosmetics and fragrances made of essential oils to place her at an advantage with men. It is believed that Cleopatra had her ship sails and robes infused with perfume, burned incense around her throne, and notably bathed in jasmine essential oil before seducing Mark Anthony, a general in the army of Julius Caesar.20
Jasmine is believed to symbolize divine hope in India, the sweetness of a woman in China, and is admired as “the perfume of love” in Muslim and Hindu traditions. Karma, the Indian god of love, is said to have tipped his arrows with jasmine blossoms in order to pierce the heart through the senses.16
Producing Jasmine Absolute Takes Thousands of Flowers
It should be noted that there are at least 43 different varieties of jasmine, although only two are used in the production of the jasmine absolute essential oil, Jasminum grandiflorum and Jasminum officinale, both natives of Southwest Asia.21 The majority of jasmine absolute is produced in Egypt and India, but France, Italy, Morocco, and Algeria produce smaller quantities.17
Because they are both extremely similar in their chemical constituents, the oils from each flower are used interchangeably in aromatherapy.16 (See Table 1.) A bad growth season of one can be compensated for with the other. This is an especially fortunate fact given that in order to produce 1 gram of jasmine absolute, about 8,000 hand-picked blossoms are needed.17
For the most part, these prized flowers are carefully hand picked as the blossoms are unfolding during the early hours of dawn. Only the fully blossomed flowers are picked and placed into a small hand-held basket with careful attention not to bruise or mishandle the flowers, as this could compromise the aroma.
The French enfleurage solvent extraction method provides the highest yield of jasmine oil, because it allows the flowers to continue to produce their oils after they are picked, providing the same natural scent as if it were still on the bush.
On the other hand, concrete extraction, the most widely-used method, is done in Egypt. Of the world’s supply of jasmine absolute, 70% to 80% is produced by the latter method, even though the absolute scent is not fully retained.17
On the Use of Jasmine
Jasmine is known for its exotic, rich, and relaxing scent.19 Yet, it is also used as a topical balming tonic for irritated skin, eczema, acute dermatitis, neurogenic pruritus, painful injuries, and ulcers.22,16 Jasmine has even been utilized in the treatment of exhaustion and labor pains.22 It is thought to speed the recovery of a woman after childbirth by dismissing postnatal depression, promoting milk flow, and intensely nurturing the woman’s feelings, femininity, and sexuality.16
Jasmine produces its aphrodisiac sensation by eliciting the release of endorphins from the pituitary gland, leading to a sense of euphoria.17 It is not a surprise that as a result of its plethora of positive effects, jasmine is found in numerous fine fragrances (see Table 2).
Allergy to Jasmine Absolute
Allergic reactions Allergic reactions from contact with jasmine essential oil have been reported.22 Jasmine absolute was also found to be one of the causes of pigmented contact dermatitis, a term coined circa 1970, describing the occurrence of gray-brown facial pigmentation in a group of middle-aged women.23
Older individuals, women more commonly than men, are especially prone to developing allergic reactions to jasmine absolute, possibly due to a greater use of fine fragrances containing the oil.24
In 2002, a multi-center study at six dermatologic centers in Europe found that 1.2% of 1,606 subjects who had a history of adverse reactions to scented products reacted to jasmine absolute on a patch test of fragrance material.25 This pivotal study was instrumental to the inclusion of jasmine absolute on the standard comprehensive screening trays.
Adulteration and Contamination
Jasmine absolute is often contaminated with unwanted chemical adulterants during the purification process, such as phthalate — a plastic softener — and ethanol.26
Many of these adulterants are purposefully added in order to drive the price down by including cheaper alternative oils, oil fractions, by-products, fillers, and jasmine synthetics (see Table 3).27
It is noteworthy to mention that 1 pound of pure jasmine absolute can cost more than $1,200, whereas a pound of synthetic jasmine can be produced for as little as $5.28 Unfortunately, it can be difficult to determine if a company is selling pure jasmine oil, if it has been diluted, or if it is synthetic.29
Despite this knowledge, many companies that purchase jasmine oil do not test or look at the major components of jasmine oil.27
Of note, the phthalate ester has been removed from many cosmetic manufacturers’ ingredients list due to potential toxicities in animal studies; hence, jasmine absolute users should be wary of the potential addition of this chemical to the oil.28 Toxicities of the phthalate ester include damage to the liver, kidney, lungs, and developing testes.30
Testing for Jasmine Sensitivity
The standard screening tray of the North American Contact Dermatitis Group (NACDG) contains 65 allergen components. Among these 65 are components specifically selected to identify top fragrance sensitizers and have included jasmine absolute, fragrance mixes 1 and 2, tea tree oil, Myroxilon pereirae (balsam of Peru), cinnamic aldehyde, and ylang ylang oil. Notably, testing with fragrance mix 1 alone is thought to identify 85% of fragrance-allergic patients.24 However, with the addition of ylang ylang oil, narcissus oil, and sandalwood oil fragrance components, the ability to detect fragrance allergy may near 95%.24, 31
The Value of This Patient Case
The patient tested positive to jasmine absolute, which demonstrates the importance of appropriate patch testing. Furthermore, with discontinued use of fragrances (a.k.a. avoidance), specifically those containing jasmine, this patient was able to remain dermatitis-free.
Dedication: This column is dedicated to master mentor in contact dermatitis, Dr. James Taylor, for his inspiration and guidance. Thank you.
