In a report of two patients who had positive patch-test reactions to benzyl alcohol in perfume and aftershave lotion, Fisher was unable to demonstrate positive reactions to 1% benzyl alcohol in saline by scratch or by intradermal or subcutaneous injections.[22] Edwards, however, reported a woman who was found to have a coexistent contact urticarial response and a type IV delayed vesicular reaction to the benzyl alcohol 1% in her sunscreen. She also had an immediate response to the sunscreen product itself.[23] Hausen reported another patient who developed angioedema after using a lip balm that contained benzyl alcohol. Subsequent patch testing showed a strong reaction to benzyl alcohol, but immediate testing was not performed.[24]
Immediate reactions have been attributed to the presence of benzyl alcohol used as a preservative in injectable medications. Hausen reported a patient who had episodes of urticaria that developed after the patient consumed one to two packets of sweets containing benzyl alcohol and after injection of a medication containing benzyl alcohol. Results of both patch and immediate tests were positive to benzyl alcohol.[24] In a separate report, Guin and Goodman described a woman with unresponsive stasis dermatitis who had been using bacteriostatic saline soaks that contained benzyl alcohol as a preservative. A 10 cm urticarial wheal developed within 1 hour at the benzyl alcohol patch-test site but faded by day 6. Prick tests were not performed.[25]
