Allergen

Sesquiterpene lactone (STL), Terpenes

“Terpenes” is the broader term for the compounds responsible for the odor of most plants (they’re the primary constituents of essential oils, so many of which are top contact allergens). Sesquiterpene lactones are a class of terpenes and are standard inclusions in patch test trays. Contact dermatitis to these substances has been reported for around 100 years, since the early 20th century.

These published top contact allergens are behind why the Asteraceae (Compositae) family and many other flowers and fruits are allergens, as well as things like turpentine, limonene, and linalool.

Note that these contact allergies can happen from exposure to even the most natural, organic terpenes and sesquiterpene lactones Many natural substances are proven contact allergens (terpenes are excellent examples), enough so that a recent study in the Journal of Drugs in Dermatology states, “We emphasize the misconception of clean, natural, organic, and vegan to equal safe … Many naturally derived ingredients are the cause of dermatitis.” Opt for validated hypoallergenic and use your patch test results to guide you.

Some skin problems associated with terpene and sesquiterpene lactone exposure:

Contact to these plants, their extracts, and/or products containing them can cause redness, itching, scaling, dryness, blistering or swelling. When the allergy is severe the symptoms can spread to sites that didn’t have direct contact or even to the entire skin surface.

Many of these contact allergens are also powerful photo-allergens — they react with light to cause hyperpigmentations (if you have underarm darkening, for example, check your deodorant for limonene, citrus, and other fragrances, fruit, and flower extracts).

Note that many of these allergens can also cause airborne contact dermatitis, leading to rashes, itching, scaling, blistering, etc. as well as hyperpigmentation, photosensitivity (sensitivity to UV radiation and indoor lights, enough so that dermatitis appears even after just a few minutes of exposure), and other symptoms even if you haven’t touched anything with terpenes or sesquiterpene lactones.

Compositae can cause generalized systemic contact dermatitis — when a person with allergic contact dermatitis develops a reaction when they are exposed to the allergen systemically (such as by eating or drinking, inhalation, injection, or other routes and not by skin contact). If you have patch tested positive to these allergens, it could be possible (hours later; peaking in a few days) to develop reactions in the skin as well as the mouth, anus, or other areas from drinking a tea with chamomile, for example. That said, remember that skin and other allergies do not often correlate — most people who patch test positive to these allergens can still safely eat vegetables in the compositae family — but correlation is possible with terpenes and sesquiterpene lactones. To be sure, ask your allergist for a prick, scratch or RAST test and your dermatologist for a skin patch test.

These substances can be responsible for more skin problems. As this review concludes, “Plant-induced contact and photocontact dermatitis can be severe and the basis for the development of other inflammatory skin diseases such as chronic actinic dermatosis.”

What to avoid:

Other ways you could be exposed to terpenes and sesquiterpene lactones include skincare, perfumes, cosmetics, and medicinal creams and ointments that contain these ingredients and related substances:

• Asteraceae flowers like arnica, chamomile, dandelion, echinacea, feverfew or chrysanthemum, liverwort, mugwort, sunflower, yarrow, etc. There are many: about 200 of this family’s 20,000 species are known to cause dermatitis.
• Essential oils and aromatherapy products
• Fragrances and perfumes. Many people (about a third) who patch test positive to sesquiterpene lactone mix also test positive to:
  • Balsam of peru
  • Fragrances, and
  • Rosin (colophony).
  • Watch for flavors as well, which tend to be related to fragrance.
• Other ingredients to avoid:
  • Alantolactone
  • Camphor
  • CAS RN:553-21-9
  • CAS RN: 477-43-0
  • CAS RN: 546-43-0
  • Costunolide
  • Costus Lactone
  • Dehydrocostunolide
  • Dehydrocostus Lactone
  • EINECS 208-899-3
• Vegetables and plants that could cause contact dermatitis from handling them or around the mouth when eating them:
  • Artichoke
  • Bay leaf
  • Endive
  • Lettuce
  • Tarragon

Some other tips that can help improve safety and comfort for sensitive skin:

• Be guided by your patch test results.
• Use fragrance-free, dye-free, paraben-free, preservative-free, allergen-free skincare and makeup.
• If you work with plants, flowers, or around substances that have terpenes or sesquiterpene lactones …
  • When on the job, use long sleeves, long pants, socks, and protective gloves and head scarves or covers (make sure they’re of materials and colors that you are not sensitive to; your patch test can guide you).
  • Applying a purely mineral, non-comedogenic barrier-protective product like Stay-On-Point! or Armada Baby or Post-Procedure on your skin before putting on gloves and other protective clothing may provide further protection from the terpenes and the textiles themselves.
  • Change out of work clothes frequently. Use an allergen-free laundry soap such as Fawn & Lauder or even Superwash!
  • Wash hands with Essence Skin-Saving Soap, Superwash, or even any of our facial cleansers.
  • Use our allergen-free moisturizers liberally on hands every day and even multiple times during the day such as after hand washing.
  • For very irritated hands, try this overnight layering intensive moisturization technique: apply moisturizer liberally all over hands. Follow with Know-It-Oil virgin coconut oil then Boo-Boo Balm. Wrap in cling wrap or pure, organic cotton cloth or socks (Cottonique makes some) and leave on overnight.

Subscribe to VMVinSKIN.com and our YouTube channel for more hypoallergenic tips and helpful “skinformation”!

If you have a history of sensitive skin…

…don’t guess! Random trial and error can cause more damage. Ask your dermatologist about a patch test.

To shop our selection of hypoallergenic products, visit vmvhypoallergenics.com. Need help? Ask us in the comments section below, or for more privacy (such as when asking us to customize recommendations for you based on your patch test results) contact us by email, or drop us a private message on Facebook.

For more:

• On the prevalence of skin allergies, see Skin Allergies Are More Common Than Ever. 
• For the difference between irritant and allergic reactions, see It’s Complicated: Allergic Versus Irritant Reaction.
• For the difference between food, skin, and other types of reactions: see Skin & Food Allergies Are Not The Same Thing. 
• On the differences between hypoallergenic, natural, and organic, check out Is Natural Hypoallergenic? and this video in our YouTube channel. 
• To learn about the VH-Rating System and hypoallergenicity: What Is The Validated Hypoallergenic Rating System?

Main References: 

Regularly published reports on the most common allergens by the North American Contact Dermatitis Group and European Surveillance System on Contact Allergies (based on over 28,000 patch test results, combined), plus other studies. Remember, we are all individuals — just because an ingredient is not on the most common allergen lists does not mean you cannot be sensitive to it, or that it will not become an allergen. These references, being based on so many patch test results, are a good basis but it is always best to get a patch test yourself.

1. Rozas-Muñoz E, Lepoittevin JP, Pujol RM, Giménez-Arnau A. Allergic contact dermatitis to plants: understanding the chemistry will help our diagnostic approach. Actas Dermosifiliogr. 2012 Jul-Aug;103(6):456-77. doi: 10.1016/j.ad.2011.07.017. Epub 2012 Jan 2.
2. Karlberg AT, Lepoittevin JP. One hundred years of allergic contact dermatitis due to oxidized terpenes: What we can learn from old research on turpentine allergy. Contact Dermatitis. 2021 Dec;85(6):627-636. doi: 10.1111/cod.13962. Epub 2021 Sep 23.
3. Urban K, Giesey R, et al. A Guide to Informed Skincare: The Meaning of Clean, Natural, Organic, Vegan, and Cruelty-Free. J Drugs Dermatol. 2022 Sep 1;21(9):1012-1013.
4. DeKoven JG, Warshaw EM, Reeder MJ, Atwater AR, Silverberg JI, Belsito DV, Sasseville D, Zug KA, Taylor JS, Pratt MD, Maibach HI, Fowler JF Jr, Adler BL, Houle MC, Mowad CM, Botto N, Yu J, Dunnick CA. North American Contact Dermatitis Group Patch Test Results: 2019-2020. Dermatitis. 2023 Mar-Apr;34(2):90-104. doi: 10.1089/derm.2022.29017.jdk. Epub 2023 Jan 19. PMID: 36917520.
5. Uter W, Wilkinson SM, Aerts O, Bauer A, Borrego L, Brans R, Buhl T, Dickel H, Dugonik A, Filon FL, Garcìa PM, Giménez-Arnau A, Patruno C, Pesonen M, Pónyai G, Rustemeyer T, Schubert S, Schuttelaar MA, Simon D, Stingeni L, Valiukevičienė S, Weisshaar E, Werfel T, Gonçalo M; ESSCA and EBS ESCD working groups, and the GEIDAC. Patch test results with the European baseline series, 2019/20-Joint European results of the ESSCA and the EBS working groups of the ESCD, and the GEIDAC. Contact Dermatitis. 2022 Oct;87(4):343-355. doi: 10.1111/cod.14170. Epub 2022 Jun 24. PMID: 35678309. https://pubmed.ncbi.nlm.nih.gov/35678309/
6. DeKoven JG, Silverberg JI, Warshaw EM, Atwater AR, et al. North American Contact Dermatitis Group Patch Test Results: 2017-2018. Dermatitis. 2021 Mar-Apr 01;32(2):111-123.
7. DeKoven JG, Warshaw EM, Zug KA, et al. North American Contact Dermatitis Group Patch Test Results: 2015-2016. Dermatitis. 2018 Nov/Dec;29(6):297-309.
8. DeKoven JG, Warshaw EM, Belsito DV, et al. North American Contact Dermatitis Group Patch Test Results 2013-2014. Dermatitis. 2017 Jan/Feb;28(1):33-46.
9. Warshaw, E.M., Maibach, H.I., Taylor, J.S., et al. North American contact dermatitis group patch test results: 2011-2012. Dermatitis. 2015; 26: 49-59.
10. W Uter et al. The European Baseline Series in 10 European Countries, 2005/2006–Results of the European Surveillance System on Contact Allergies (ESSCA). Contact Dermatitis 61 (1), 31-38.7 2009.
11. Wetter, DA et al. Results of patch testing to personal care product allergens in a standard series and a supplemental cosmetic series: An analysis of 945 patients from the Mayo Clinic Contact Dermatitis Group, 2000-2007. J Am Acad Dermatol. 2010 Nov;63(5):789-98.
12. Warshaw EM, Buonomo M, DeKoven JG, et al. Importance of Supplemental Patch Testing Beyond a Screening Series for Patients With Dermatitis: The North American Contact Dermatitis Group Experience. JAMA Dermatol. 2021 Dec 1;157(12):1456-1465.
13. Verallo-Rowell VM. The validated hypoallergenic cosmetics rating system: its 30-year evolution and effect on the prevalence of cosmetic reactions. Dermatitis 2011 Apr; 22(2):80-97.
14. Ruby Pawankar et al. World Health Organization. White Book on Allergy 2011-2012 Executive Summary.
15. Misery L et al. Sensitive skin in the American population: prevalence, clinical data, and role of the dermatologist. Int J Dermatol. 2011 Aug;50(8):961-7.
16. Warshaw EM1, Maibach HI, Taylor JS, Sasseville D, DeKoven JG, Zirwas MJ, Fransway AF, Mathias CG, Zug KA, DeLeo VA, Fowler JF Jr, Marks JG, Pratt MD, Storrs FJ, Belsito DV. North American contact dermatitis group patch test results: 2011-2012.Dermatitis. 2015 Jan-Feb;26(1):49-59.
17. Warshaw, E et al. Allergic patch test reactions associated with cosmetics: Retrospective analysis of cross-sectional data from the North American Contact Dermatitis Group, 2001-2004. J AmAcadDermatol 2009;60:23-38.
18. Marks JG, Belsito DV, DeLeo VA, et al. North American Contact Dermatitis Group patch-test results, 1998 to 2000. Am J Contact Dermat. 2003;14(2):59-62.
19. Warshaw EM, Belsito DV, Taylor JS, et al. North American Contact Dermatitis Group patch test results: 2009 to 2010. Dermatitis. 2013;24(2):50-99.
20. Verallo-Rowell V. M, Katalbas S.S. & Pangasinan J. P. Natural (Mineral, Vegetable, Coconut, Essential) Oils and Contact Dermatitis. Curr Allergy Asthma Rep 16,51 (2016) . https://doi.org/10.1007/s11882-016-0630-9.
21. de Groot AC. Monographs in Contact Allergy, Volume II – Fragrances and Essential Oils. Boca Raton, FL: CRC Press Taylor & Francis Group; 2019.
22. De Groot AC. Monographs in Contact Allergy Volume I. Non-Fragrance Allergens in Cosmetics (Part I and Part 2). Boca Raton, Fl, USA: CRC Press Taylor and Francis Group, 2018.
23. Zhu TH, Suresh R, Warshaw E, et al. The Medical Necessity of Comprehensive Patch Testing. Dermatitis. 2018 May/Jun;29(3):107-111.

Want more great information on contact dermatitis? Check out the American Contact Dermatitis Society, Dermnet New Zealand, the Contact Dermatitis Institute, and your country’s contact dermatitis association.

Laura is our “dew”-good CEO at VMV Hypoallergenics and eldest daughter of VMV’s founding dermatologist-dermatopathologist. She has two children, Madison and Gavin, and works at VMV with her family and VMV’s signature “skinfatuated, skintellectual, skingenious” team. In addition to saving the world’s skin, Laura is passionate about health, cultural theory, human rights, happiness, and spreading goodness (like a VMV cream)!