Balsam of Peru FAQ

Balsam of Peru is a naturally occurring sticky substance that is harvested by wounding the Myroxylon pereirae tree, found in South 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 subunit 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 subunit groups can simplify the avoidance diet, making it easier to follow.

Contact Dermatitis refers to a condition where an allergy to a certain chemical (the allergen) causes itching or a rash on your body. The reactions are delayed from the time of exposure, usually from 48-96 hours. These chemicals may be found in items such as topical lotions, creams or medications, gloves, shoes, clothing, jewelry, hair dyes, other cosmetics, perfumes, and numerous other sources in the environment. While there is no definitive cure, many people are able to improve their symptoms partially or completely by AVOIDANCE of their known allergens and when needed using appropriate medications in times of flares. One of the most commonly identified allergen causes of allergic contact dermatitis is BOP (a substance marker for fragrance allergy).

Contact dermatitis will develop once you have been exposed to enough times, (repeated ‘dosing’). Every person is different in terms of how many times and how much chemical they need to be exposed to in order to react. However, for this type of allergy there is a threshold (dose level) at which enough exposure to the chemical causes the rash or itching. At the point when you have a sustained rash, you have reached your threshold dose for reactivity. On some days you may have less contact with the chemical you are allergic with and thus your symptoms will come and go, as the dose rises and lowers. Again, once you pass your threshold, your rash can stay (persist) or recur in the same place.

Patch Testing is the method for detecting and confirming these contact allergies. Specific chemicals in substances that come in contact with the skin can be tested. The chemicals or substances to be tested are applied to plastic or metal disks on stickers and then placed on the skin of the back or upper inner arms. These chemicals are in specific appropriate concentrations. They will be covered with tape, and remain in place for approximately 48 hours. Your provider will then remove them, and check for reactions again at 72-120 hours after application. You will not receive any injections.

No. Patch testing detects only one type of allergy (called delayed hypersensitivity reactions), the type that produces redness, itching, and sometimes tiny blisters on the skin.

The type of allergy that causes sneezing, sinus congestion, asthma, or hives is detected by another technique called scratch testing; this type of allergy is usually caused by cat or dog hair, trees, grasses, flowers, foods, etc. Allergists and immunologists perform this test with small injections on your back and arms.

The back and arms are the sites for application. Note, no corticosteroid (“cortisone”) creams or ointments or over-the-counter lotions or creams should be applied to the area where the patch tests will be placed for several days (preferably about two weeks) before coming in for patch tests. Also, it is important that you not get a sunburn or tan on your back 2 weeks prior to testing. Please shave your back (if it’s hairy) two days before your patch test appointment to minimize discomfort during the procedure.

Preferably, yes. It is important that your back be clear. Should your back not be clear enough for testing, your procedure may have to be postponed.

Three. You will have three (3) procedure visits. Patch tests are applied on the first day of the procedure. The patches are removed and initial results are read on the second procedure visit. A third procedure visit is required to perform a final evaluation of your patch test results.

Yes. Oral “cortisones” such as prednisone and medrol tablets. Do not receive any injections of “cortisone” for four weeks before patch testing. Anti-histamines do not interfere with the results, so these may be taken as your provider indicates.

Patch tests are generally safe. The patch test has been used since its discover in 1895 by Josef Jadassohn. They have been used on thousands of patients, and side effects are rare. Common things patients notice are itching, sweating, tape pulling or feeling tight. Some people feel discomfort and stickiness when the tape is pulled off, or may notice redness, burning, and sometimes blisters (where a test turns positive).

Flares of the patient’s original dermatitis, during the patch test procedure, may be noted. This is because your skin remembers your allergic spot. Make sure to tell your provider about previous reactions, and discuss any questions or concerns you may have with them.

At the final reading your results will be given to you by your provider. You should be given a list of the chemicals you reacted to, and be informed on which are most likely relevant to your dermatitis (based on your history and exposures).

You should be given information about the common places these allergens are found, and ways to avoid them.

Your provider might be a member of an electronic database resource, such as the American Contact Dermatitis Society’s Contact Allergen Management Program, and provide you with a computerized list of all the products that do not contain the chemicals that were identified on patch testing (devoid of the chemicals you reacted to on your test).