Aromatherapy offers important benefits to health, and those who have knowledge of this holistic intervention recognize that it is based on essential oils, a natural pharmaceutical1 that is physically isolated from the plant.2 Those who are unfamiliar with the science of aromatherapy may incorrectly ascertain that many scented commercial products are kindred to therapeutic, plant-based aromas. In fact, these heavily marketed consumer products, including household cleaners, scented candles and air fresheners, laundry products, linen sprays, carpet scents, and personal beauty and hygiene products are fragranced with chemicals that are not independently reviewed for safety or verified by an objective third party. There is no legal requirement for full disclosure of fragrance ingredients in scented products,3 making it impossible to isolate specific chemicals that may be contributing to adverse health effects triggered by particular compounds.

Fragrance sensitivity is a growing public health concern, and there is evidence to support the need for fragrance-free and fragrance-limited workplaces, health care agencies, and other public venues. Fragrance chemicals may trigger adverse effects on multiple body systems that manifest as asthmatic responses, mucosal irritation, migraine headaches, skin conditions, anxiety, and others. There may be concurrent concerns about liability exposure. Needing to avoid workplace bathrooms to eliminate risk of adverse reactions to fragrant cleansers potentially violates the Americans with Disabilities Act.3 In fact, the Superior Court of New Jersey, Appellate Division, found that a licensed practical nurse (LPN) with a 4-decade history of cigarette smoking and a preexisting condition of chronic obstructive pulmonary disease (COPD) was entitled to worker's compensation following a workplace exposure to air-sprayed perfume that triggered a COPD exacerbation that ultimately led to a permanent need for supplemental oxygen. The court determined that the fragrance exposure while at work was the direct mechanism of the COPD exacerbation. The previously employed LPN was no longer able to work. Therefore, the employer was responsible for the injury.4

The Canadian Medical Association (CMA) acknowledges the many symptoms people attribute to scent sensitivities, including headaches, rhinitis, sneezing, gagging, coughing, and dyspnea and comments that there are many institutions and agencies that have responded to these concerns by implementing fragrance-free or scent-reduction policies. The CMA describes the supporting evidence as "fuzzy," "inconclusive, and generally unjustified."5^(pE315) The association credits much of the science of smell and scent reactions to the Monell Chemical Senses Center, the only independent, not-for-profit, scientific institute in the world that is focused on basic, interdisciplinary research on taste and smell.6

The Monell Chemical Senses Center conducted a study to determine whether negative expectations could elicit or worsen odor-triggered asthma symptoms following a 15-minute exposure to a nonirritating, rose-like smelling odorous chemical, phenylethyl alcohol. Subjects (N = 17) were assigned to 2 groups; one group was prepared with information as to the harmful nature of the scent, whereas the other group was told that the fragrance had therapeutic effects. Findings showed that subjects who believed that the odor might be harmful experienced airway inflammation, and this inflammation persisted for 24 hours postexposure. The group informed of the benefits of the scent did not experience this inflammatory response. Researchers concluded that some adverse fragrance effects on breathing might be related to the expectation of harm. In other words, if a person believes that fragrance will contribute to airway narrowing, it is more likely to occur.7

An unrelated study explored eye and nasal irritation in asthmatic patients post-scent exposure and found no evidence of pulmonary function decline or nasal mucosal swelling following 30 minutes of exposure to 2 scented aerosols.8 The study compared subject reports of negative symptoms when exposed to fragrance to objective changes in the eyes and the airway. The researchers concluded that preexisting expectations were likely responsible for the subjective symptoms experienced post-fragrance exposures.8

A recent online survey study took a different approach to explore the multiple dimensions of exposure to fragranced consumer products and their effects in the US population.3 Data were collected from a random, nationally representative sample (N = 1156) drawn from a large US Web-based panel of more than 5 million people. Survey queries explored a number of dimensions including fragrance exposure, health effects, impact of workplace and societal fragrance exposure, ingredient awareness, preferences, and demographic data.

Approximately one-third of respondents reported health problems when introduced to scented products. Findings revealed that 98.3% of the American populace was exposed to scented products weekly as a result of personal use and 92.1% was exposed weekly from others' use. Some people (15.1%) could not use public toilets because of air fresheners and other scented products, including soap. Many experienced workplace difficulties, including missed days of work, as a result of fragrance exposure. The researcher concluded that limiting exposure to perfumed products can reduce risks and improve indoor and outdoor air quality and emphasized that many scent exposures are involuntary and create societal restrictions.3

It is time for health care professionals to consider fragrance exposures and respond to available evidence. The Massachusetts Nurses Association provides compelling information about the effects of fragrances and offers good resources for those holistic care providers who are interested in fragrance-free policies, including Web sites for fragrance-free information, a model for a fragrance-free policy, a sample of fragrance survey, and advocacy information.9 The Oregon Nurses Association advocates for nurses to learn more about fragrance sensitivities and participate in cooperative efforts to accommodate the needs of the millions of Americans who are adversely affected by fragrances.10 The Canadian Centre for Occupational Health and Safety offers a free 30-minute webinar to learn about fragrance sensitivities, fragrance-free policies, and workplace-related challenges.11 An information-rich, Web-based resource information is Women's Voices for the Earth.12 The best and most immediate contribution that holistic care providers may elect to consider is to limit or cease personal use of aromatic products in the practice environment and encourage colleagues to do the same.

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