Work-Related Asthma Associated with Fragrance Exposures in California

BACKGROUND: There are approximately 3000 chemicals used to make fragrances. A fragrance is typically a complex mixture composed of up to a few dozen of these chemicals, some of which are known to cause or exacerbate asthma. Fragrances are added to many products, including air fresheners, personal care products, and cleaning products. Fragrance exposures may affect workers in a variety of workplace settings including when scented products are used at work, or where scented personal care products are used by others. This analysis characterizes cases of work-related asthma associated with fragrance exposures in the work environment and discusses prevention strategies.    

METHODS: We examined work-related asthma surveillance data collected in California from 1993-2012. Cases were ascertained from four data sources, and we administered telephone interviews and reviewed medical records to confirm cases and collect additional information related to risk factors, medical history, and workplace exposures. Standardized coding systems were used to summarize exposure, occupation, and industry information. Cases were identified as fragrance-related if workers with confirmed work-related asthma reported perfume or air freshener exposures as being associated with their asthma symptoms in the workplace. We present descriptive statistics about fragrance-exposed cases and comparisons with non-fragrance-related cases for a variety of variables. Case reports illustrate the impact of fragrance exposures on workers.

RESULTS: A total of 7,163 confirmed cases of WRA were identified in California between 1993 and 2012, including 270 cases associated with exposure to fragrances. Perfume was the ninth most common exposure among all cases in this time period. When compared to non-fragrance cases, fragrance cases were significantly more likely to be female (94% versus 62%, p<0.0001), older (median age 48 versus 42, p<0.0001), and classified as having work-aggravated asthma (38% versus 20%, p<0.0001). Fragrance cases were significantly more likely to be in office, health, and education jobs than non-fragrance cases, and six occupations accounted for 35% of the cases. Fragrance cases were significantly more likely to still be exposed in the workplace (50% versus 26%, p<0.0001), but non-fragrance cases were more likely to have a workers’ compensation claim awarded (76% versus 67%, p=0.07).

CONCLUSIONS: Some chemical constituents in fragrances are known asthmagens. Fragrances are an important asthma exposure in the workplace and present an opportunity for prevention. Some workers report that employers refuse to address their fragrance-related asthma problems, leading to repeated exacerbations. Model fragrance-free workplace policies exist and can reduce work-related asthma by eliminating fragrance exposures.