Asthma in the workplace, second edition. Bernstein IL,, Chan-Yeung M, Malo JL, Bernstein DI, eds. New York: Marcel Dekker, Inc., 1999 Jun; :341-361
Many exposures in the workplace that can result in occupational asthma can also cause a variety of dermatological problems. These include irritant contact dermatitis, allergic contact dermatitis (Type IV delayed hypersensitivity), and urticaria (Type I immunologic and nonimmunoIogic). Urticaria will be discussed here because of its more direct association with occupational asthma, in terms of both clinical coexistence and mechanistic similarities. Urticaria is defined as the transient appearance of elevated, erythematous pruritic wheals or serpiginous exanthem, usually surrounded by an area of erythema. In addition, areas of macular erythema or erythematous papules may also be present. These skin lesions appear and peak in minutes to hours after the etiological exposure and individual lesions usually disappear within 24 hours. Urticarial lesions usually involve the trunk and extremities, although they can involve any epidermal or mucosal surface. Large wheal formation, where the edema extends from the dermis into the subcutaneous tissue, is referred to as angioedema. This condition is more commonly seen in the more distensible tissues, such as the eyelids, lips, ear lobes, external genitalia, and mucous membranes. Urticarial wheals result from local subcutaneous and intradermal leakage of plasma filtrate from postcapillary venules. The erythema and surrounding swelling result from locally increased blood flow. Biopsy specimens of urticarial lesions may exhibit only subtle microscopic changes. There may be evident subcutaneous or dermal edema, an increase in the number of mast cells, and a modest perivascular lymphocytic infiltrate, perhaps intermingled with cosinophils. Electron microscopy reveals mast cell and eosinophilic degranulation.
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