Illustration: Karolina Burdon
Illustration: Karolina Burdon

HEALTH

Could certain fragrances be making you ill?

A new book says that fragrance causes health problems for over a third of people. So why aren’t we talking about it?

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By Kate Grenville on

In 2008 Susan McBride, a senior city planner, was finding life difficult. She worked in an open-plan office for the City of Detroit. Within a few minutes of arriving at work every day, she started to cough and wheeze, and couldn’t catch her breath. She consulted doctors, who did tests and confirmed that her symptoms came from being exposed to fragrance.

She discussed the problem with her colleagues. Some of them liked to wear strong perfumes. Others used desktop fragrance diffusers or air fresheners. She explained that any of those smells made it hard for her to breathe. She asked them, as a favour to her, if they’d consider taking their fragrance diffusers home, and waiting till the end of the work day to put on their perfume.               

Her colleagues couldn’t believe that anyone could get sick from what they thought were lovely scents. Surely she was making a fuss about nothing. Eventually they agreed to remove the fragrance diffusers and air fresheners and little bowls of potpourri. But they wouldn’t stop wearing the perfumes they loved.                

Susan McBride knew about other of offices that had “low-scent” policies. She went to her supervisor to ask if a policy like that could be brought in for their office, too. She didn’t need a completely fragrance-free environment – “low-scent” would have solved her problem. Her employers refused. They claimed that it would be unconstitutional to stop her colleagues wearing perfume.                

One day at work her symptoms got so bad that she collapsed. She was taken to hospital and recovered, but she realised she couldn’t return to her workplace while it was full of fragrance. But she wasn’t ready to retire. She enjoyed the job, and she needed the money. She got a lawyer with experience in disability claims and took her employer to court.

The Americans with Disabilities Act defines a disability as something that interferes with a “major life activity”. It’s illegal to discriminate against someone on the basis of a disability, and employers are obliged to accommodate an employee’s disability as far as they can. The court found that Susan McBride’s fragrance allergy was a disability since, as the judge said, her reaction to other people’s fragrance “interfered with the major life activity of breathing”. It found that her employers should have accommodated her disability, and awarded McBride compensation of US$100,000.     

Susan McBride’s case set a dramatic precedent. Other employers all over North America scrambled to make sure they wouldn’t be the next to take a hundred-thousand-dollar hit. Many workplaces in the US and Canada – government offices, private businesses, hospitals, schools and universities among them – now have “low-scent” or “fragrance-free” policies.                        

***                        

There’ve been a few similar cases in Australia. In 2014 a public servant, we’ll call her Jane Smith, worked for the department of human services. Like Susan McBride, she got sick when she was exposed to the fragrance her colleagues were wearing. She felt nauseous and dizzy, developed a headache, and had difficulty breathing.     

Some of her colleagues were sympathetic, and were willing to help her by going easy on the perfume and cologne. But others told her the problem was all in her head. They thought she was just being difficult. How could fragrance make someone sick? Management told her that asking people not to wear fragrance would be discriminatory.    

She struggled on until one day, like Susan McBride, she collapsed at her desk and had to be taken to hospital. It was clear she couldn’t go back to work, and she was retired as medically unfit. But, like Susan McBride, she didn’t want to retire, and took the employer’s insurers to the Administrative Appeals Tribunal for compensation for permanent impairment and non-economic loss.                        

At the tribunal hearing, five doctors’ reports were submitted (one from a professor of immunology) which verified that her symptoms were triggered by fragrance. There was no argument about that. The argument turned on the legal definition of “impairment”. In the Australian system, claims for permanent impairment can only be paid if the impairment affects at least 10 per cent of the whole person. The lawyers for the employer argued that, since her impairment only occurred when she was exposed to fragrance, this was less than 10 per cent.

These cases make visible what’s usually not: fragrance makes some people seriously sick

A savvy lawyer for Jane Smith might have mounted an effective challenge against this argument. A lawyer might even have suggested bringing a civil case, based on anti-discrimination laws, rather than going through the AAT and haggling about the arithmetic of impairment. The outcome might well have been different. But Smith couldn’t afford a lawyer, and the tribunal found it was “not satisfied that [the plaintiff’s] whole person impairment meets the minimum level of 10 per cent in the Act.” She lost her case, and any chance for compensation.                

A few similar cases have been successful here in the UK. Another public servant was unable to attend a training seminar because of the participants’ fragrance. She won her case and was compensated to the tune of a few thousand dollars. Comparable cases, involving the inability to access shops or other premises because of fragrance, have been settled out of court. But no Australian case has delivered a financial penalty hefty enough to bring about fragrance-free policies in our workplaces, the way Susan McBride’s case did in the US.

These cases make visible what’s usually not: fragrance makes some people seriously sick. Their ability to work or study or even do something as simple as catch a bus is impaired by a choice that someone else is making. But aren’t they just an unlucky few? If this problem was widespread, wouldn’t we be hearing more about it?

It turns out that Susan McBride and Jane Smith are the tip of an iceberg. Problems caused by fragrance – headaches, breathing difficulties and skin rashes – are common enough that researchers have tried to put a number on them. The numbers are surprising.                        

In the absence of any really clear idea about what causes headaches or how to prevent them, specialist doctors spend a great deal of energy classifying them. There are migraine headaches, tension headaches and cluster headaches. There are stabbing headaches, thunderclap headaches and ice-pick headaches. There are cocaine-induced headaches and caffeine-withdrawal-induced headaches. It seems the only category that’s missing is fragrance-induced headaches.                        

All over the world there are doctors who do nothing but treat headaches. There’s an International Headache Society. There are seven headache clinics within a half- hour’s drive of my home. There are books and scholarly journals devoted to nothing but headaches. No wonder: the World Health Organization’s research indicates that, globally, up to one adult in twenty has a headache every, or nearly every, day.   

Not only that: more people are getting more headaches, more often. The prevalence of migraines (especially among younger people) is increasing – one Danish study, comparing rates from 1994 with those from 2002, put this increase at around a third. An American study showed that between 1979 and 1981 there was a “striking” increase in migraines among people under forty-five. Over those three years, migraines among women increased by more than a third. Among men, the increase was 100 per cent.         

All this suggests that headaches are a problem with no easy answers.

This is awful for people with headaches, but there’s a bright side: it means there’s a huge body of research. People unlucky enough to have frequent, severe headaches give specialists a ready-made set of test subjects.

Most headache research is about the particular kind called migraine. These are headaches severe enough to put people to bed in a darkened room for days while powerful drugs attempt to beat back the throbbing pain. Any kind of normal life, including going to work, is out of the question while a migraine is underway. The World Health Organization has put migraine on its list of the ten leading causes of disability, affecting one adult in seven. All studies show that women suffer from migraines much more than men – the prevalence among women is around three times that of men.            

Despite decades of research, doctors don’t fully understand why migraines happen. But they do know that many people have a migraine trigger. Stress is a common trigger, flickering lights another. Folk wisdom maintains that red wine, chocolate and oranges are migraine triggers, though the research I read didn’t mention any of these. But it did point the finger at one: fragrance.                       

Folk wisdom maintains that red wine, chocolate and oranges are migraine triggers, though the research I read didn’t mention any of these. But it did point the finger at one: fragrance

A study from 2001 of patients with migraines found that smells set off headaches in 60 per cent of them. Smells also made headaches worse for 68 per cent of patients. The study concluded that a “nose-sinus involvement” in headache could be more important than was generally realised. Another study a few years later, of over a thousand migraine sufferers, was more specific about smell. It found that around 44 per cent of patients named “perfume or odour” as one of the things that triggered their headaches.

A 2014 study, following on from these findings, was even more specific: of the patients whose migraines were set off by odours, nearly 76 per cent named “perfume” as a trigger. It was the single most common odour trigger for migraines (followed by paint, about 42 per cent, and petrol, about 28 per cent). The study concluded that “odorants...especially perfume, may trigger migraine attacks after a few minutes of exposure.”                        

One more of the many examples was a study that looked at nearly a hundred male migraine sufferers. (Men and women often have different triggers for their migraines. This study was only of men.) Odours were the second most frequent trigger for their migraine attacks (48 per cent), behind stressful situations (52 per cent). Odours were also the second most frequent worsening factor (73 per cent), just behind excessive light (74 per cent). Of the odours, the worst for triggering attacks were perfume, cigarette smoke and fragranced cleaning products.                   

What all these numbers boil down to is that, among people who get migraines, around half get them from fragrance.                      

But those studies are about the migraine kind of headache. What about the people like me, whose headaches aren’t generally bad enough to send us to a doctor, just enough to ruin our day? Putting a number on that question is harder, as you might expect. We aren’t neatly corralled in headache clinics with doctors recording our symptoms. Mostly we just pop another headache pill and soldier on.

But a few researchers have come up with some figures. They’re not as firm as the headache-clinic numbers, because they’re mostly based on people answering questions. Some people, for instance, might think they get a headache from fragrance but really get headaches for another reason, while others might not have put two and two together about their headaches and the smell of fragrance. These surveys could include both over-reporting and under-reporting. Still, the research has come up with some significant numbers.           

The New South Wales department of health does regular telephone surveys to investigate general health issues. In 2002 one of the questions they asked was: “Do certain chemical odours or smells regularly make you unwell?” Just under a quarter of the people surveyed said they did. Tantalisingly, the survey didn’t specify what kind of chemical odours were causing problems.                  

But several other surveys did. In 2004 a thousand people in the US were surveyed by random phone interview. Thirty-one per cent reported adverse reactions to fragranced products. A few years later another survey, again of a thousand people, confirmed these results: 30 per cent found scented products worn by other people irritating. Nineteen per cent suffered adverse health effects from air fresheners. Eleven per cent were irritated by scented laundry products.                       

A third survey, in 2016, found that nearly 35 per cent reported health problems such as respiratory difficulties and headaches when exposed to fragrance. (To be exact, 18 per cent suffered respiratory problems; 16 per cent had red, watery eyes or nasal congestion; nearly 16 per cent had headaches; and eight per cent had an asthma attack. Smaller numbers experienced skin problems, cognitive difficulties such as an inability to concentrate, or gastrointestinal problems such as nausea.) Fifteen per cent had lost workdays or a job due to exposure to fragrance in the workplace.                    

The fragrance conversation is an awkward one to have. How do you tell someone that the way they smell is making you ill?

What all that means is startling: out in the general population, fragrance causes health problems for over a third of people. To put that in human terms, if you’re one of sixty people on a bus going to the city in the morning, up to twenty people around you may be getting unwell from fragrance.

The real numbers of people who get sick from fragrance are almost certainly bigger than the studies show. The studies are done, and the numbers counted, in clinics where the symptoms are treated. But for every person who’s sick enough to see a specialist, there are many others who just soldier on.

As I was researching this book people would ask me, “What are you working on now?” At first I was embarrassed to admit what I was doing. Why was a novelist writing a book about fragrance? But as time went on I became braver. “I get headaches from fragrance, so I’m writing a little book about it,” I’d say.                        

What happened next was always interesting. Some people would give me the “uh oh, she’s flipped” look. But many people got a certain kind of faraway look on their face. “Oh, fragrance…” they’d say, and then they’d launch into their own fragrance story.                        

There was the writer friend who couldn’t stop sneezing whenever she visited her mother-in-law, because of the fragrance she wore. Another writer chimed in to tell us about the headaches she got from perfumes she described as “those awful musky ones people wear!” There was the academic who had to sit at the other end of the room when she was in a meeting with a certain colleague who wore a lot of “product” in his hair. There was the man who’d had to stop taking the lift at work, because the fragranced women in that small space made him start sneezing embarrassingly.

The woman serving me in the fruit shop overheard one of these conversations and cried: “Oh, that incense they burn everywhere! Makes me sick to the stomach!” There was the ophthalmologist at the Sydney Eye Hospital who gets asthma from fragranced patients. His secretary always warns them beforehand not to wear it but, if they do, the doctor sends them down the hall to the bathroom to wash it off. If that doesn’t work, they have to go home and come back another day. The publisher of my book – after urging me to write a novel instead of a book about fragrance – casually mentioned that scented products give him a rash. My editor told me that strong perfumes give him a headache.

What I was hearing seemed like a kind of epidemic. Yet it was a silent one. Some of the people who told me their stories were friends I’d known for years, yet I’d never known this about them. I had the strong impression that fragrance was bothering many people, but no one was talking about it.         

It’s understandable. Fragrance is supposed to be wonderful. We’re supposed to love it. Surely only a weirdo wouldn’t enjoy the smell of flowers or pine forests? So everyone puts up with it, thinking they’re the only one. Besides, the fragrance conversation is an awkward one to have. How do you tell someone that the way they smell is making you ill?                   

Yet most people know that they’re likely to get a headache or start coughing from the smell of fresh paint. We know there are things in paint that the human body doesn’t like, but they’re the same things that make the paint stick to the wall, so we put up with the discomfort. We try to minimise it by doing what it says on the tin: make sure there’s plenty of ventilation. So it’s not such a strange and unfamiliar thing to get sick from certain smells.                

With paint, the smell is an unintended by-product. But with fragrance, the smell is the whole point. The things that make that “good smell” are the same ones that make people sick.

That’s when you start wondering exactly what’s in those bottles. Isn’t it just the smell of flowers?

This is an edited extract from The Case Against Fragrance, published by Text Publishing Company.

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Illustration: Karolina Burdon
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