Aquagenic Urticaria : Symptoms, Causes, Treatment, Prevention and More

Overview

Water is essential for human beings. And for most people, it does not cause any adverse reaction. However, it is not the case for individuals with a rare condition called Aquagenic Urticaria. People suffering from this condition develop hives and rashes rapidly when their skin comes in contact with water.

What is aquagenic urticaria?

As mentioned above, aquagenic urticaria is a rare condition in which itching develops when there is contact with water. It is a type of hive that appears rapidly after the skin comes in contact with water, irrespective of its temperature.

This is a form of physical hives associated with itching and burning. The condition can affect anyone, but it generally affects women. The symptoms often start around the onset of puberty or after.

The hives or rashes can occur anywhere on the body. However, they are more likely to appear on the neck, the upper part of the torso, and the arms. There is no harm in drinking water if it doesn’t touch the skin. But there are cases where individuals suffering from this condition may get an allergic reaction on their lips or inside the mouth when drinking water. Other water sources such as rain, sweat, snow, and tears can trigger hives or rashes.

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What are the symptoms of aquagenic urticaria?

Aquagenic hive is a rare condition that might cause an itchy, painful rash when the skin comes in contact with water. The rash may appear anywhere on the body. But it commonly appears on the neck, arms, and chest. These symptoms disappear within 30 to 60 minutes after the skin dries. Within minutes of being exposed to water, people with this condition might experience:

• Reddening of the skin
• Burning sensation
• Lesions
• Welts
• Inflammation

In more severe cases, drinking water can also cause people to experience symptoms including:

• Rash around the mouth
• Difficulty swallowing, breathing
• Wheezing

Sometimes, a person may get other symptoms such as headaches, shortness of breath, dizziness, and fainting.

When should you consult a doctor?

Visit a healthcare provider if you develop hives that do not disappear within 60 minutes of drying the skin or after medication.

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What is the cause of this condition?

The exact cause of aquagenic urticaria is unknown. Some researchers speculate that chemical additives in the water, such as chlorine, can cause the reaction rather than contact with the water itself.

The allergy-like symptoms that people may experience from these rashes are due to histamine. If people have an allergic reaction, their immune system releases histamine as a response to fight the harmful substance. This may trigger allergy-like symptoms.

People can also get an allergic reaction when the water interacts with a substance applied to the skin such as sunscreen, perfumes, and other skincare products.

What are the risk factors for aquagenic urticaria?

The risk factors for aquagenic urticaria are unknown. A family might have more than one case, but the majority of the cases do not occur in family groups. So far, there have not been an adequate number of cases for researchers to decide if the condition is inherited or whether it may be part of a larger syndrome.

How is aquagenic urticaria diagnosed?

The doctor will conduct a physical examination to assess the symptoms to diagnose aquagenic urticaria. They will also review the medical history and may also perform a water challenge test during which the doctor will apply a water compress of 95°F (35°C) to the upper body to trigger a reaction. The symptoms should appear within 15 minutes.

The doctor will record the response to the water challenge test and compare it to the symptoms of aquagenic pruritus, which causes itching and irritation but does not cause hives or reddening.

What are the treatment options?

There is no cure available for aquagenic urticaria. However, there are treatment options that are available to reduce the symptoms including: 

1. Antihistamines: This treats hives, regardless of the type. Doctors choose second-generation antihistamines since they cause less drowsiness than the older formulas. Cetrizine is a frequent choice.
2. Creams or other topical agents: These agents create a barrier between water and the skin, such as petroleum-based products that can be used before taking a bath or when there are other forms of exposure to water, to stop water from penetrating the skin. Experts and healthcare providers recommend using these agents before using antihistamines, especially for children allergic to water.
3. Ultraviolet light therapy: This commonly used treatment is also known as phototherapy. It uses ultraviolet light to harden the skin, similar to the palms and the soles of the feet, making it less sensitive to water.
4. Omalizumab: This is an off-label medication for hives, as it is a medication to treat asthma. This medication has reportedly been tried successfully in some people with aquagenic urticaria. However, it is an expensive drug.
5. Steroid medication, like Stanozolol has demonstrated effectiveness in some cases, A class of medications called SSRIs (Selective Serotonin Reuptake Inhibitors) were also been correlated with positive results. 

How to prevent further outbreaks of aquagenic urticaria?

People with aquagenic urticaria should take care to limit their contact with water as much as possible. This includes reducing their frequency of bathing, wearing moisture-proof clothes, and being careful in moist and rainy weather.

Conclusion

Aquagenic urticaria is a form of urticaria and hives that itch and burn. The exact underlying cause of aquagenic urticaria is currently not known. People experiencing the symptoms must consult a doctor to decide on the correct treatment option depending on the ‘water test’ challenge result. To prevent further flare-ups, people must limit their contact with water whenever possible.

Frequently Asked Questions

Is this condition curable?

Unfortunately, this condition is not curable. But it is manageable with the right treatments and dietary changes.

Who can get this condition?

Anyone can get this condition. But women are more prone to this condition than men.

How many cases of aquagenic urticaria are reported in the medical literature?

As this is a rare condition, less than 100 cases have been reported in the medical literature.