A Rare Water Allergy- Aquagenic Urticaria

A Rare Water Allergy- Aquagenic Urticaria

Aquagenic urticaria is a very rare condition during which urticaria (a type of hives) develop immediately after the skin comes directly in contact with water.

Aquagenic urticaria causes physical aquagenic hive which is associated with burning and itching. The physical hives from this condition can be triggered by many water sources such as tears, sweat, rain, and snow.

During this condition, the hives caused by aquagenic urticaria are usually small and are red- or skin-colored welts. The welts generally disappear within 30 to 60 minutes. hives information is not influenced by water source or temperature.

In most of the time, aquagenic urticaria affects women and its symptoms start around the start of puberty.

This condition is rarely found, therefore only a limited amount of data regarding the effectiveness of individual treatment is present.

This condition requires more investigation and study related to its treatment. However, various therapies and medications have been used to treat this condition which requires more accurate research. In medical literature, fewer than a hundred cases of aquagenic urticaria are reported.

Symptoms of Aquagenic Urticaria

Aquagenic urticaria is a condition which causes itchy urticaria (hives) rapidly after the skin directly comes in contact with water. The itchy hives develop regardless of the water temperature.

The hives caused by aquagenic urticaria are usually small (approximately 1-3 mm) and are red- or skin-colored welts, having clearly defined edges. These aquagenic rashes mostly develop on the neck, arms and upper trunk.

It can occur anywhere on the body. Generally, the rash fades within 30 to 60 minutes Once the water source is removed. Some of the common symptoms of aquagenic urticaria are the following:

  • Inflammation
  • burning sensations
  • itching
  • Reddening of skin or erythema
  • Skin Lesions
  • Welts

Some people can also experience severe symptoms associated with aquagenic urticaria, which occurs after drinking water. Some of such symptoms are the following:

  • Wheezing
  • Difficulty in swallowing
  • Difficulty in breathing
  • Hives or rashes around the mouth

Causes of Aquagenic Urticaria

The main cause of aquagenic urticaria is not properly known. However, researchers are still working to determine the main cause of aquagenic urticaria.

Some of the scientists have proposed that the chemical additives in the water such as chlorine cause hives rather than the contact with water itself. These added dissolved substances such as chlorine enter the skin and trigger the immune system of a person.

It is also considered that the aquagenic hives are not caused by water, specifically, but rather by an allergen present in the water. The allergen activates the immune system and causes the release of histamine which leads to the development of allergy-like symptoms including rashes.

Aquagenic urticaria can also be caused by an interaction of water with a substance found on the skin which generates a toxic material. In this way, Aquagenic hives are produced.

Diagnosis of Aquagenic Urticaria

Typically, aquagenic urticaria can be diagnosed based on the presence of characteristic symptoms.

After the analysis of aquagenic urticaria, “water challenge test” can be performed to confirm the diagnosis.

During the “water challenge test”, a compress of 35ºC water is applied to the upper body for 30 minutes.

Most commonly, the upper body is affected as compared to other areas such as the legs. Therefore, the preferred site for the test is the upper body.

The patient is requested not to have any antihistamines for several days prior to the test.
Other tests like rinsing affected areas of the body with water or giving a direct bath and shower challenges are also attempted to diagnose aquagenic urticaria.

These tests are used when the usual “water challenge test” using a small water compress is negative.

Treatment of Aquagenic Urticaria

Aquagenic urticaria (AU) is a rare condition and very limited data is available regarding the effectiveness of individual treatments. In the present time, no large-scale study is performed on this condition. In other types of physical urticaria, the use of causative agents can be avoided whereas the avoidance of water is not practical. However, the following treatments have been used to reduce the symptoms of aquagenic urticaria.

  • Antihistamine

In this condition, antihistamines are used as first-line medical therapy. The antihistamines that block H1 receptors (H1 antihistamines) are preferred such as cetirizine which is non-sedating.

In the case where H1 antihistamines are not effective, other H1 antihistamines can be used. Hydroxyzine and cimetidine are examples of H2 antihistamines.

  • Petrolatum-based products

The topical agents or other creams can also be used to reduce the symptoms. These agents serve as a barrier between the skin and water. Example of such products is petrolatum-based products. These products can be used prior to bathing or other exposures to the water. Its use can prevent water penetration into the skin.

  • Ultraviolet Light Therapy

Ultraviolet light therapy is also known as “phototherapy”. The use of phototherapy usually resolves the symptoms of aquagenic urticaria in a few cases. The example of such therapies is ultraviolet radiation B and psoralens radiation A.

  • Omalizumab

It is an injectable medication which is typically used to treat people with severe asthma. Its use has also been proved effective against a few people suffering from aquagenic urticaria

As this condition is rare and limited data is available, therefore, people suffering from aquagenic urticaria should consult with their doctors prior to the use of any kind of medication.

In some cases, medical treatment is not found effective against aquagenic urticaria. These people may need to rely on minimizing water exposure by avoiding water-based activities and limiting the bathing time.

Inheritance of Aquagenic Urticaria

Most cases of aquagenic urticaria occur randomly among individuals. However, few cases with familial history cases have been reported on several occasions. In some cases, the patient had an association with other conditions also.

In simple words, the family members having aquagenic urticaria also had another potentially inherited medical condition. However, no specific inheritance pattern has been found associated with the symptoms of aquagenic urticaria.

Final Thoughts

Aquagenic urticaria is a rare condition and only a few cases related to it are reported. However, it can show various symptoms depending upon the severity of the condition.

Very limited treatments are available to treat this condition which should be used with the consultation of the doctor. More research is required the investigate this condition.



Hilary Jensen

Hilary is a Food Science and Nutrition graduate with specialization in diet planning and weight loss. She enjoys reading and writing on Food, Nutrition, Diet, Weight Loss, and General Health.

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