Fragrance allergy & perfume allergy

There are some things that we would expect medicine to understand better.  I have a patient who had a nagging cough for months last year until she figured out that she was allergic to the perfume that her husband had given her a week before the symptoms started.  I had treated her with antihistamines, inhaled steroids .. etc etc.  The pulmonologist had no idea .. nor did the ENT.

But the literature on fragrance allergy remains sparse .. and while there are a few web pages devoted to this topic .. I think that since it's so poorly understood, we physicians are not educated about it.

My perspective in this is a bit more than professional as well.  I have seasonal allergies, like many of the 300 million people in this country.  Yet when I'm around someone with perfume or cologne — or even heavily scented handcreams, lotions, etc .. I get runny eyes, sneezing, and terrible headaches.  Antihistamines (Claritin, Allegra, etc) can help proactively .. but won't help once exposure has occurred.

So I would have been more thoughtful, and perhaps I should have thought of the perfume. But this is a sensitive topic .. and people take their scents very seriously.   I often feel that I'm depriving new parents when I tell them to use baby products without dyes or perfumes. 

"But then he won't smell like a baby!"  … they tell me. 
"But at least he won't have a rash from all of the extra chemicals you're exposing him to".. I thinks to myself.

I now do take a careful "perfume allergy" history when I interview patients with recurrent symptoms such as headache, rhinitis, or cough/sneezing.  Sometimes, they simply don't believe me.  My 35 year old man with asthma stopped using his cologne for a month and got much better .. but then went back to it .. and predictably, the symptoms returned.