Balsam of Peru Diet
Balsam of Peru is a naturally occurring sticky substance that is harvested by wounding the Myroxylon pereirae tree, found in Central America. It has an odor similar to cinnamon and vanilla. Notably, it cross-reacts with a number of synthetic fragrances found in perfumes, lotions, cleaning products, etc. It is a natural substance containing hundreds of components that also cross react with both natural and synthetic food flavorings.
In a significant number of people (but not all), who are confirmed on patch testing to be allergic to BOP, avoidance of skin contact with fragrances will lead to resolution of their allergic contact dermatitis (rash). For a smaller subset of people (those more sensitized), avoiding fragrances is not enough. In these people, ingesting (eating/drinking) of foods high in BOP can trigger a widespread rash.
The standard patch test screening kit screens for the whole balsam of Peru extract. In those with widespread rashes who have significant improvement on the low balsam diet, identification of the subgroup may be beneficial. A diary of associated food flares can help identify the sub-unit food groups. When available, a more extended patch test may be able to detect the individual component allergies, specifically benzoates, vanillin, ferrulic acid, cinnamates, and coniferins.
Because the complete low balsam of Peru diet can be a challenge to follow, identifying trigger foods within the sub-unit groups can simplify the avoidance diet, making it easier to follow.