medications, and perfumed products. Among foods, the most commonly implicated are spices, citrus, and tomatoes. People allergic to balsam of Peru may benefit from a diet in which they avoid ingesting foods that contain it. Naturally occurring ingredients may contain substances identical to or very closely related to balsam of Peru, and may cause the same allergic reactions. In some instances, balsam of Peru is listed on the ingredient label of a product by one of its various names, but it may not be required to be listed by its name by mandatory labeling conventions (in fragrances, for example, it may simply be covered by an ingredient listing of "fragrance"). To determine if balsam of Peru is in a product, often doctors have to contact the manufacturer of the products used by the patient. Before 1977, the main recommended marker for perfume allergy was balsam of Peru, which is still advised. The presence of balsam of Peru in a cosmetic will be denoted by the INCI term Myroxylon pereirae. Because of allergic reactions, since 1982 crude balsam of Peru has been banned by the International Fragrance Association from use as a fragrance compound, but extracts and distillates are used up to a maximum level of 0.4% in products, and are not covered by mandatory labeling. In March 2006, the European Commission, Health and Consumer Protection Directorate-General, Scientific Committee on Consumer Products, issued an opinion on balsam of Peru. It confirmed that crude balsam of Peru should not be used as a fragrance ingredient, because of a wide variety of test results on its sensitizing potential, but that extracts and distillates can be used up to a maximum level of 0.4% in products. History The name balsam of Peru is a misnomer. In the early period of Spanish invasion in Central and South America, the balsam was collected in Central America and shipped to Callao (the port of Lima) in Peru, then shipped onward to Europe. It acquired the name of "Peru" because it was shipped via there. Its export to Europe was first documented in the seventeenth century in the German pharmacopoeia. Today it is extracted under a handicraft process, and is mainly exported from El Salvador. Another balsam, balsam of Tolu, is extracted from Myroxylon balsamum var. balsamum in a different way. Alternate names Among the alternate names used for balsam of Peru are: balsam Peru Peru balsam Peruvian