At least 70 people have died in a suspected chemical attack in Douma, the last rebel-held town in Syria's Eastern Ghouta, rescuers and medics say.
Volunteer rescue force the White Helmets tweeted graphic images showing several bodies in basements. It said the deaths were likely to rise.
There has been no independent verification of the reports.
Syria has called the allegations of a chemical attack a "fabrication" - as has its main ally, Russia.
The US state department said Russia - with its "unwavering support" for Syria's government - "ultimately bears responsibility" for the alleged attacks.
What do we know about the attack?
Several medical, monitoring and activist groups reported details of a chemical attack.
"Seventy people suffocated to death and hundreds are still suffocating," said Raed al-Saleh, head of the White Helmets. An earlier, now deleted tweet, put the number dead at more than 150.
The pro-opposition Ghouta Media Center tweeted that more than 75 people had "suffocated", while a further 1,000 people had suffered the effects of the alleged attack.
It blamed a barrel bomb allegedly dropped by a helicopter which it said contained Sarin, a toxic nerve agent.
The Union of Medical Relief Organizations, a US-based charity that works with Syrian hospitals, told the BBC the Damascus Rural Specialty Hospital had confirmed 70 deaths.
Could there be repercussions for Damascus?
Following the latest attack, the UK Foreign Office urged an international response.
But Russia said allegations of a chemical attack "were staged".
US President Donald Trump ordered a cruise missile attack against Syria following the Khan Sheikhoun attack a year ago. Last month, the Washington Post newspaper reported that Mr Trump had discussed the possibility of another American attack on Syria with top security officials, but decided not to take action.
Days later, Defence Secretary Jim Mattis warned that it would be "unwise" for Syria to launch chemical attacks.
French President Emmanuel Macron has threatened to strike Syria if the government uses chemical weapons against civilians.
The US once again said Russia is "ultimately bearing responsibility" for all chemical incidents in Syria, regardless of who carried them out, after rebel sources accused Damascus of gassing dozens in Eastern Ghouta's Douma.
"The regime's history of using chemical weapons against its own people is not in dispute," said the US State Department, indicating, however, that it was relying on "reports," being unable to confirm the incident. "Russia ultimately bears responsibility for the brutal targeting of countless Syrians with chemical weapons."
Earlier on Saturday, rebel-linked activists, including the notorious 'civil defense' group White Helmets, accused the Syrian government of carrying out a chemical attack that allegedly affected dozens of civilians in the militant-controlled town of Douma in Eastern Ghouta. The Syrian government, which regards the White Helmets as a foreign-funded terrorist propaganda mouthpiece, rejected these "fabrications."
"Jaish al-Islam terrorists are repeating the allegations of using chemical weapons in order to accuse the Syrian Arab army, in a blatant attempt to hinder the Army's advance," Sana reported, citing an official government source, who added that militants have likely launched this latest propaganda campaign fearing their imminent "dramatic collapse."
Despite the lack of verified evidence thus far, Washington did not miss a chance to label Moscow as complicit and 'ultimately' responsible for the incident, due to its support of President Bashar Assad. Previously, former Secretary of State Rex Tillerson regularly took advantage of well-timed reports of chemical incidents, including in East Ghouta, to push through the US agenda in Syria.
In a follow-up comment, the State Department urged the international community to act “immediately” – if the incident is confirmed – and advised Russia to end its “unmitigated” support for the Syrian government.
Reports of chemical attacks, blamed on Damascus, previously surfaced on a number of occasions, and were often backed by a stream of horrific visuals disseminated via social media channels by the White Helmets. Saturday's incident follows the same pattern, where, as always, the White Helmets found themselves at the right place at the right time to take graphic pictures of the alleged chemical attack victims. Shocking images of dead kids with foaming mouths surfaced immediately after the accusations were made.
Quite surprisingly, the controversial UK-based Syrian Observatory for Human Rights, which is usually among the first sources that confirm atrocities by Damascus, could not confirm that chemical weapons had been used, and said casualties might have been a result of fire and toxic smoke following a conventional airstrike.
Earlier, the US State Department had expressed concern about the reports of chemical weapons use in Douma that allegedly led to deaths of 40 people, claiming that Russia was accountable for targeting Syrians; the Russian military has refuted the allegations, saying they were aimed at disrupting of Jaysh al-Islam militants' evacuation from E Ghouta.
"Information attacks about the use of chlorine or other poisonous substances by the Syrian government troops are continuing. Another such hoax about the supposedly taking place of the chemical attack in Douma emerged yesterday. At the same time, references are made to the notorious NGO "White Helmets", which has been repeatedly caught acting with terrorists, as well as other so-called humanitarian organizations based in the United Kingdom and the United States," the ministry said.
The ministry went on to say that it had repeatedly warned about possible provocations with the use of chemical weapons in Syria. Their major aim is to accuse the Syrian government forces of the chemical weapons use and justify the possible military intervention in Syria from abroad.
The Syrian government has denied allegations of having used chemical weapons in the city of Douma in Eastern Ghouta, saying it doesn't need such measures to stop the terrorists.
The Russian Defense Ministry has also denied reports of an alleged chemical bomb being dropped on Douma, suggesting that a number of Western states as well as NGOs like the White Helmets have turned to such claims in order to undermine the evacuation of Jaish al-Islam terrorists from the area.
"We strongly deny these claims and announce our readiness to send Russian experts in radiation, chemical and biological defense to Douma after its liberation from terrorists to gather evidence, which would prove that the allegations on the chemical weapons use were staged," said Maj. Gen. Yuri Yevtushenko, commander of the Russian Center for Syria reconciliation.
According to the statement, issued by the Syrian authorities on the state-run SANA news agency, such claims have been made by terrorists and are aimed at hindering Syrian forces, which have made “a swift and determined advance” and do not need such measures to deter the terrorists.
SANA, citing an official source, reported that some media outlets, affiliated with the Jaish al-Islam terrorist group, positioned in its last stronghold in Douma, had reiterated the allegations of chemical attack in order to blame it on the Syrian Arab army and hinder the forces’ advance.
Last month, Damascus reported that several foreign experts were working on staging a chemical attack, which would be carried out with the help of the infamous White Helmets and would be covered by mainstream media. The same warning was issued by the Russian Center for Syria reconciliation in January.
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