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Query: UMLS:C0042109 (urticaria)
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During the anthrax outbreak and threat in Trenton (2001), our allergy practice experienced increased visits from approximately 50 of our regular patients with symptoms they believed resulted from anthrax exposure. In all cases, their symptoms were caused by a combination of an exacerbation of their underlying allergic disease and anxiety because of possible exposure to anthrax. Our objective is to present an orderly approach to the allergist's outpatients presenting with possible exposure to a bioterrorist's agent. The 10 precepts of approach to the management of a biological casualty (index of suspicion, protect yourself, patient assessment, decontaminate, diagnose, treat, infection control, alert authorities, assist in investigation, and maintain proficiency) and the epidemiological characteristics of a biological attack are discussed. In table form, we compared the signs and symptoms of the most common outpatient consultations to an allergist's office practice (chronic rhinitis, asthma, food allergy, venom allergy, atopic dermatitis, drug allergy, chronic urticaria, acute urticaria, immunodeficiency, and anaphylaxis) with those of likely bioterrorism threats. Descriptions of smallpox, plague, tularemia, anthrax, viral hemorrhagic fevers, Q fever, brucellosis, Venezuelan equine encephalitis, glanders, and melioidosis are presented. Patients may readily mistake their allergic symptoms with those of infection with a bioterrorist's agent. At the same time, the allergist may be faced with one of his own chronic patients presenting with symptoms resembling their allergic disease but actually caused by one of the aforementioned pathogens.
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PMID:Biological terrorism and the allergist's office practice. 2178 3

This chapter is complementary to Chapter 4 published in the same series. Airborne contact dermatitis (ABCD) is considered a prototype in the field of environmental dermatology. It is often underestimated in most textbooks of general dermatology, despite its frequent occurrence in daily life. ABCD may be irritant, allergic, phototoxic, or photoallergic. Airborne contact urticaria is another example. A particular clinical aspect is the "head and neck dermatitis", which occurs in atopic adult patients. Occupational ABCD represents a most difficult issue in terms of diagnostic procedures. It is obvious that non-occupational ABCD cases involve similar problems, usually easier to solve, and our comments refer to both conditions. Two examples of potentially airborne skin infections (e.g., anthrax and Ebola virus hemorrhagic fever) are also described because they are closely related to the same problematics. A new example of airborne irritant contact dermatitis, not reported so far, is linked with the use of continuous airway pressure in the treatment of obstructive sleep apnea.
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PMID:Environmental airborne contact dermatoses. 2525 46