Introduction
Reactions
Investigations
Treatment
Prevention
Alternative names
Balsam of Peru is a sticky aromatic liquid that comes from cutting the bark of the tree Myroxolon balsamum, a tree that is native to El Salvador. The ‘Peru’ part of Balsam of Peru originates from when it was first named, El Salvador then being part of a Peruvian colony. Balsam of Peru smells of vanilla and cinnamon because it contains 60-70% cinnamein (a combination of cinnamic acid, cinnamyl cinnamate, benzyl benzoate, benzoic acid and vanillin). The other 30-40% contains resins of unknown composition. It also contains essential oils similar to those in citrus fruit peel. These are all potential allergens.
Balsam of Peru is not only used for its aromatic and fixative (i.e. delays evaporation) properties but also for its mild antiseptic, antifungal and antiparasitic attributes. It has 3 main uses: fragrance in perfumes and toiletries; flavouring in food and drink; healing properties in medicinal products. The table below lists some of the products that may contain Balsam of Peru and/or chemically related substances.
Fragrance |
Flavouring |
Medicinal |
|---|---|---|
|
|
|
Typical allergic contact dermatitis reactions may occur in individuals allergic to Balsam of Peru or any other chemically related substances. A flare-up of hand eczema is common in sensitive individuals if they use or consume products containing Balsam of Peru or related allergens. Oral exposure may cause sore mouth (tongue) and a rash of the lips or angles of the mouth.
Sensitivity to a perfume or cream is usually the first indicator of an allergy to Balsam of Peru. Patch testing using 25% Balsam of Peru in petrolatum is used to confirm this. A positive result to Balsam of Peru is seen in 50% of fragrance allergy cases. Positive patch test also indicates that the individual may have problems with flavourings (both artificial and natural), some medications and other perfumed products.
Most people tested for fragrance allergy will be patch tested with Balsam of Peru and fragrance mix (a mixture of 8 commonly used individual fragrances). This detects approximately 75% of fragrance allergy cases.
Self-testing a product for Balsam of Peru is possible but should be done only after first talking with your doctor. This should be done only with products that are designed to stay on on the skin such as cosmetics and lotions. Apply a small amount (50 cent sized area) of the product to a small tender area of skin such as the bend of your arm or neck for 5 days in a row. Examine the area each day and if no reaction occurs, you are unlikely to be allergic to it. However, it may still cause an irritant reaction, so be cautious. Products such as shampoos, conditioners, soaps and cleansers should not be tested in this way as they frequently cause irritant dermatitis.
Once dermatitis appears on the skin, treatment is as for any acute dermatitis/eczema, i.e. topical corticosteroids, emollients, treatment of any secondary bacterial infection (Staphylococcus aureus), etc.
If you have an allergy to Balsam of Peru, try to identify possible sources of contact and avoid them. Use only ingredient-labelled products that do not list Balsam of Peru or any of its other names on the label. If you are unsure ask your pharmacist for advice and a suitable alternative.
Alert your doctor or dentist to the fact that you have an allergy to Balsam of Peru. If you are highly sensitive, your doctor may also recommend a special diet that eliminates foods to which this allergen or related allergen is added as a flavouring.
Allergy to Balsam of Peru may make you sensitive to other chemically related substances. Many of these are spices and flavourings that are used in daily cooking. As a precaution, you should avoid using these products, as it is likely that you will be allergic to them too.
Your dermatologist may have further specific advice, particularly if you are highly sensitive to Balsam of Peru.
Cross reactions:
Appearance: sticky transparent liquid
Sensitizer: benzyl acetate, benzoyl alcohol, cinnamic acid, cinnamic alcohol, cinnamic aldehyde, eugenol, isoeugenol
Patch Test: 25% Balsam of Peru in petrolatum
Book: Fisher's Contact Dermatitis. Ed Rietschel RL, Fowler JF. Lippincott Williams & Wilkins 2001
