A negative breakdown test in a fragrance mix I‐positive patient does not rule out contact allergy to its fragrance constituents

Background In about half of the patients reacting positive to fragrance mix I (FM I), breakdown testing remains negative. This raises the question of whether the reaction to FM I is false‐positive, or the breakdown test is false‐negative. Objectives To identify characteristics and sensitization patterns of patients positive to FM I, but not to its fragrance constituents. Patients and Methods Retrospective analysis of data from the Information Network of Departments of Dermatology (IVDK) between 2005 and 2019. Three patient groups were defined according to their reaction pattern: Group I, FM I positive and ≥1 single fragrance positive in the breakdown test (n = 1912); Group II, FM I positive and breakdown test negative (n = 1318); Group III, FM I negative (n = 19 790). Results Regarding the pattern of concomitant reactions to other fragrances, Group II had an intermediate position between Group I and Group III. In other respects (age and sex distribution, frequency of sensitization to non‐fragrance baseline series allergens), Group II rather resembled Group I. Conclusions Not every positive reaction to FM I in patients with negative breakdown tests is false‐positive. There may be false‐negative reactions to the single fragrance components when patch tested at 1% pet. Raising patch concentrations of some single fragrances is recommended.