Understanding Aquagenic Urticaria: The Rare Water Allergy

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Everyone knows that water is essential for all life. Now, imagine having a condition where this life-sustaining substance triggers an allergic reaction.

This is an extremely rare water allergy called Aquagenic Urticaria. This condition, though uncommon, leads to an allergic reaction upon contact with water, regardless of temperature.

In this blog post, we will discuss Aquagenic Urticaria, exploring its symptoms, causes, diagnosis, as well as possible treatment options.

📌 Key Takeaways

  • Aquagenic urticaria is a very rare form of hives that is triggered by exposure to water.
  • The cause of this condition is unknown.
  • It can be managed through different oral and topical medications.

🤔 What is Aquagenic Urticaria?

Aquagenic urticaria is an extremely rare form of urticaria AKA hives. Essentially when your body comes into contact with water you develop hives or a rash.

This allergy is so rare there have been less than 100 reported cases. While there is a higher prevalence of diagnosis among females, the typical age of onset is around puberty.

Some cases of aquagenic urticaria have been familial, suggesting there may be a genetic component as well. However, most reported cases are sporadic.

Aquagenic urticaria symptoms

📝 Symptoms

Within 20 to 30 minutes of exposure to water, this condition leads to hives or a rash typically located on your arms, chest and trunk, while the palms of your hands and soles of your feet are usually spared.

Hives or “wheals” are typically 1-3mm in size. The wheals usually resolve on their own within 30-120 minutes after no longer having contact with water. Alongside the wheals, the allergic reaction may be accompanied by a burning sensation, itching or swelling

In some cases, even drinking water can result in swollen lips or a rash around the mouth. Very rarely, in severe cases some individuals may have shortness of breath or wheezing.

🩺 Diagnosis of aquagenic urticaria

A medical doctor is responsible for diagnosis of this condition and may suspect it if someone has a history of hives after skin contact with water.

Given the rareness of this condition it is important that the doctor rule out other causes of urticaria (hives). There are several forms of urticaria that have similar signs and symptoms to aquagenic urticaria so it’s important that these are also considered as a possible diagnosis.

Once all other causes of urticaria are excluded, how is aquagenic urticaria diagnosed? In order to diagnose the condition, a patient must undergo a water challenge test AKA as a water provocation test.

The water challenge test requires applying water to a cloth, applying the cloth to the patient’s upper trunk for 30 minutes, and assessing the patient’s skin for a hive-like reaction.

Doctor checking the patient for urticaria

❗️ Causes

While experts have hypothesized the pathogenesis of aquagenic urticaria, the exact cause of this allergy is not well understood.

One of the hypotheses suggest that the itchy hives are formed because the water might be reacting with unknown components in the skin causing a histamine release from mast cells AKA allergy cells.

However, it is not clear at this time why the histamine is released.

Aquagenic urticaria can be triggered regardless of temperature, saltiness or pH. For example, even an individual’s own sweat and tears could trigger the hives. In general, any water exposure triggers the hives.

💊 Treatment Options

Obviously, it is not feasible to avoid water completely even if you suffer from aquagenic urticaria. This is because even though you may have the condition or water allergy, your body still needs water to survive.

Therefore, the main goal of treatment is to minimize or prevent symptoms induced by water exposure.

Medications

One of the main forms of treatment is to take a second generation antihistamine prophylactically. This means you take the medication before you have symptoms in order to prevent the onset of symptoms.

Examples of this medication include Zyrtec or Claritin, which are non-sedating. These types of medications are meant to prevent your allergy symptoms.

There are some that may not improve with this type of antihistamine, so a medical doctor may recommend Xolair to prevent any flare ups from occurring.

Woman taking antihistamine pills

Therapies

Some may benefit from phototherapy, which is a therapy to treat certain skin disorders. Essentially, it thickens the wall of the skin to prevent water from getting underneath the skin. It also helps to reduce the allergy cell activity.

Topical Treatments

Some topical treatments or topical medications like petrolatum can be beneficial because they prevent water penetration into the skin. Hypothetically, if the medication could reduce water penetration, symptoms may be less likely to occur.

🩹 Coping Strategies

If you suffer from chronic urticaria (regardless if it’s aquagenic urticaria) and have a flare up you may find relief with the following suggestions:

  • If you have aquagenic uritcaria try to dry your skin as soon as possible after exposure
  • Wear loose clothing so that it doesn’t rub on your hives
  • Prevent yourself from getting too cold or hot
  • Use calamine lotion or other anti-itch lotions

Limit Exposure

Of course, one of the easiest ways to minimize your symptoms is to limit your exposure to water. However, it is not reasonable to completely avoid water since it is necessary to maintain hygiene and consume water for hydration purposes.

There are some simple ways to limit your exposure though. This may require you to shower less frequently or wear gloves when washing dishes for example.

Washing dishes with gloves on hand

📑 Conclusion

Since this is a rare condition, there is not much research on aquagenic urticaria.

There are certainly many diagnostic and management challenges with this allergy because it often has the same symptoms of other allergies.

Not only that, but it is unclear what exactly causes this allergy and we also do not know if aquagenic urticaria ever resolves on its own.

As mentioned, this is a very rare condition so it’s very unlikely that you have this particular allergy. But, if you are experiencing any allergy-like symptoms mentioned in this article, be sure to consult with your medical doctor for diagnosis and treatment.

❔ Frequently Asked Questions

How Do You Get Rid of Aquagenic Urticaria?

It is unclear what causes aquagenic urticaria so therefore it is difficult to get rid of the condition. In fact, it is not known if this allergy resolves on its own or if it resolves at all. However, the allergy can be managed through antihistamine medications and different topical treatments.

Can You Shower if You Have Aquagenic Urticaria?

It would be unreasonable to avoid water altogether with this allergy. This is because it is essential for life and you do need to maintain hygiene.

However, if you happen to have this very rare condition it would be recommended to limit your water exposure by avoiding where or when you can. For example, you may still shower but maybe you shower less frequently or for shorter periods of time.

What Causes Aquagenic Hives?

Currently, it is unclear what causes aquagenic urticaria. There are some hypotheses discussed in the article above, however a cause of the histamine release has not been identified yet.

  • Roxanne Trotter
    MS, RDN

    Registered Dietitian Roxy, fueled by her love for food and wellness, tackles misinformation head-on. Her Master's in Human Nutrition and diverse experience (weight management, hospitals) equip her to translate complex health topics, especially those related to water quality. Through her own practice (Nutremedies LLC) and writing for Water Filter Guru, Roxy empowers readers with accurate, evidence-based information, helping them make informed choices for a healthier life, one sip at a time.

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