Balsam of Peru

What is Balsam of Peru?  

Balsam of Peru comes from the trunk of a tree grown in Central and South America. It is a natural aromatic resinous balsam that contains a mix of a number of substances that are related to Cinnamon, Vanilla and Clove fragrance and flavourings.  

If in a personal care product it will be labelled as MYROXYLON PEREIRAE (the Latin name for the plant) but you will need to avoid other fragrances as well. Other names are PERUVIAN BALSAM.  

What is the scale of the problem?  

A number of surveys have identified Balsam of Peru as being in the ‘top five’ allergens most commonly causing patch test reactions in people referred to dermatology. It is a marker for allergy to perfumed products. People frequently call the Allergy UK helpline for information about this allergen and how to avoid the products it is in, when they have been found patch test positive. 

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Where is it found?  

Balsam of Peru is a marker for allergy to perfumed products such as perfumes & toiletries. Similar chemicals are used in food and drink for flavouring. Balsam of Peru is also used in medicine and pharmaceutical products for its healing properties. It has known antibacterial & antifungal properties. Further on in this factsheet, there is a list of products, in which it is commonly found. The constituents are well known and include benzyl benzoate, benzoic acid and farnesol (found in deodorants) and nerolidol. 

Signs and symptoms  

These include allergic contact dermatitis/ eczema skin reactions such as: redness, swelling, soreness, itching (pruritus), and blisters. In oral exposure, symptoms can include inflammation of the lips, mouth and tongue. If swallowed it may cause itching and contact dermatitis around the anal area (back passage). 

Diagnosis  

The diagnosis is usually made by a Dermatologist or a Dermatology Specialist Nurse by patch testing.  

Management  

This involves avoiding contact with products that contain Balsam of Peru or related chemicals, which means avoiding fragranced, and perfumed products. Only fragrance free/unscented products should be used. Do not rely on the fragrance free claim, but check the ingredient label of all products that you buy to use on the skin to ensure that they do not include parfum or a fragranced plant extract.  

Some medicinal products contain Balsam of Peru including treatment for haemorrhoids, chilblains, burns and scabies. Your GP or Dermatologist may prescribe treatment for the symptoms, but it is best to try to prevent them through avoidance. 

Other advice  

  • Check all product labels for ingredients or material safety data sheet (MSDS) enclosed in packaging, before buying or using a product  
  • Only use fragrance free products where possible i.e. soap, shampoo. Avoid parfum in any product  
  • If in doubt ask the pharmacist, doctor or Specialist Nurse 
  • Write to the manufacturer if further information is required If unsure, check products, before use by applying to hollow of the elbow twice daily for a week to check it does not cause a rash  
  • A positive test may indicate allergy to spices as the ones below (usually where there are oral or anal symptoms due to swallowing)  
  • Most patients with a positive test to Balsam of Peru can eat a normal diet  
  • Only if your symptoms are potentially related to food i.e. on the lips, may your doctor recommend a special diet 

Balsam of Peru smells of cinnamon because it contains 60-70% cinnamein (a combination of cinnamic acid, cinnamyl cinnamate, benzyl benzoate, benzoic acid and vanilla). It also contains essential oils similar to those in citrus peel. These are all potential allergens.  

Known Balsam of Peru products to be aware of…  

Fragrance: Perfumes, deodorant’s, aftershave lotions, cosmetics, baby powders, sunscreens, suntan lotions, shampoo and conditioners, perfumed tea, household products, air fresheners, insect repellents, cleaning products, aromatherapy and essential oils tooth paste and mouthwash , chewing tobacco  

Flavouring: citrus fruit peel, spices such as cinnamon, vanilla, cloves, paprika, curry, cardamom, nutmeg, products such as chewing gum, sweets, cola, and colalike soft drinks, and occasionally foods that may cause problems with Balsam of Peru allergy such as beer, wine, coffee, chocolate, ice cream, wine, tomatoes  

Medicinal: medicated creams and lotions including Haemorrhoid cream such as Anusol (which is a common source of sensitisation), surgical dressings, cough mixtures, lozenges, Tincture of Benzoin, Chinese Balm, Tiger Balm, calamine lotion, eugenol (in dental preparations), lip balms and creams. 

Alternative names and cross reactivity 

 Alternative names or chemicals that cross react with Balsam of Peru and cause an allergic reaction.  

  • Myroxylon Pereirae or Myrosperum Pereira  
  • Eugenol and Isoeugenol 
  • Components in essential oils obtained from spices including cloves, cinnamon leaf. pimento, nutmeg, camphor, roses, carnations, hyacinths and violets.  
  • Benzoin, Benzoic Acid, Benzyl Alcohol (Sodium Benzoate)  
  • Rosin (colophony), wood and coal tars Citrus fruit peel 
  • Tiger balm (chinese proprietary ointment)  
  • Cinnamic acid, Cinnamic alcohol,  
  • Vanilla  
  • Balsam of Tolu