Aquagenic urticaria refers to hives caused by exposure to water. It is also known as water allergy and is an extremely rare condition, with only 37 cases reported in medical research.
Aquagenic urticaria is an extremely rare form of urticaria (hives) that causes a rash to appear after you touch water. The hives may appear red or similar to the color of your skin tone. They may be harder to see on darker skin.
It’s a form of chronic inducible urticaria (CIndU)
Aquagenic urticaria is considered a water allergy. However, research confirming this is limited. A
Most cases begin in or shortly after puberty and are most common in persons assigned female at birth. Additionally, genetics may play a role.
Various water sources can trigger hives from this condition, including:
- rain
- snow
- freshwater
- seawater
- sweat
- tears
Water temperature, pH and saltiness, or anxiety do not usually cause this type of hives.
Aquagenic urticaria is also different from a cold allergy or cholinergic urticaria, which is an allergic reaction to heat. The reaction caused by aquagenic urticaria occurs directly from exposure to water, regardless of its temperature.
Aquagenic hives appear as a scratchy, stinging rash. This rash usually occurs on the chest, neck, and arms. Sometimes hives can appear anywhere on the body except on the soles of the feet and palms of the hands.
Within minutes of being exposed to water, people with this condition can experience:
- erythema, or reddening of the skin
- burning or prickling sensations
- welts
- inflammation
- rash
When you dry your body, symptoms should begin to fade within 30 minutes to 2 hours.
For some people, drinking water can cause them to experience symptoms including:
In more severe cases, you may develop the following symptoms of anaphylaxis:
- difficulty swallowing
- wheezing
- shortness of breath or difficulty breathing
Seek immediate medical attention if you experience anaphylaxis.
Anaphylaxis
Anaphylaxis is a severe reaction to a trigger, such as an allergy, and is potentially life threatening.
Symptoms can come on quickly and include:
- feeling faint or lightheaded
- difficulty breathing or wheezing
- rapid heartbeat
- confusion
- anxiety
- clammy skin
- collapsing or losing consciousness
- hives
- swelling
- stomach pain, nausea, or vomiting
If you or someone around you develops these symptoms, you should:
- Check to see whether they have an epinephrine pen. If they do, read and follow the instructions to dispense the medication.
- Dial 911 (or a local emergency number).
- Lay them down. If they have vomited, lay them on their side.
- Stay with them until emergency services arrive.
It is possible for someone to need more than one injection with an epinephrine pen. If symptoms do not begin to clear after 5 minutes, give a second injection if one is available.
Researchers are
When you have an allergic reaction, mast cells underneath the skin
To diagnose aquagenic hives, your doctor will conduct a physical exam to observe your symptoms. They’ll also review your medical history and may also perform a water challenge test.
During this test, your doctor will apply a room-temperature water compress to your upper chest for 30 minutes. This test is done to trigger a reaction.
Your doctor will record your reaction to the water challenge test and compare it to symptoms of a similar condition called aquagenic pruritus. The difference between these two disorders is that aquagenic pruritus causes itching and irritation but doesn’t cause hives or reddening.
Additionally, the doctor may apply salty water, ice, and heating pads to
There’s no cure for aquagenic hives. However, there are treatment options available to relieve symptoms.
For short-term relief of itching, swelling, and irritation, you’ll likely need to take an antihistamine, which is a medication used to treat allergy-like symptoms.
Preferably, this involves a less sedating second-generation antihistamine, such as cetirizine (Zyrtec) or loratadine (Claritin), to prevent your hives before contact with water.
Some people may not improve using antihistamines, and the doctor may add omalizumab (Xolair) to prevent flare-ups.
Phototherapy may provide some benefits by thickening the top skin layer and preventing water from getting under the skin.
If you have a severe case of aquagenic hives and can’t breathe, you may need to use an EpiPen. These auto-injector pens contain epinephrine, also called adrenaline, your fright-flight hormone.
Epinephrine increases blood pressure and reduces throat swelling and hives. In addition, they open up the lungs when they have started to close because of a severe allergic reaction.
Learn how to use an Epi-Pen.
Anaphylaxis
Anaphylaxis is a severe reaction to a trigger, such as an allergy, and is potentially life threatening.
Symptoms can come on quickly and include:
- feeling faint or lightheaded
- difficulty breathing or wheezing
- rapid heartbeat
- confusion
- anxiety
- clammy skin
- collapsing or losing consciousness
- hives
- swelling
- stomach pain, nausea, or vomiting
If you or someone around you develops these symptoms, you should:
- Check to see whether they have an epinephrine pen. If they do, read and follow the instructions to dispense the medication.
- Dial 911 (or a local emergency number).
- Lay them down. If they have vomited, lay them on their side.
- Stay with them until emergency services arrive.
It is possible for someone to need more than one injection with an epinephrine pen. If symptoms do not begin to clear after 5 minutes, give a second injection if one is available.
When a flare-up of hives happens, you can try the following for relief:
- make sure the skin is completely dried immediately
- avoid getting too hot or cold
- wear loose-fitting clothes, or remove clothes at the site of the hives
- sit by a fan (not for cold-triggered hives)
- apply calamine lotion or over-the-counter anti-itch medication (when water is not an ingredient)
Once you receive your doctor’s diagnosis of aquagenic hives, it is best to avoid touching water.
Still, this isn’t practical for everyday life. So, try to restrict your contact with water as much as possible. Preventing a flare-up includes:
- apply mineral oil or 100% petroleum jelly to the skin before showering
- using dry shampoo and waterless cleansers in-between showers
- taking short, periodic showers
- wearing clothes that draw moisture away from the skin
- wearing cotton-lined dishwashing gloves when cleaning
- prepare for rainy, snowy weather
Remembering to take your medication and following your treatment plan can decrease hive outbreaks. If your treatment plan is not working, contact your dermatologist for suggestions.
Does aquagenic urticaria ever go away?
So few people worldwide have aquagenic urticaria that it is unknown if it will resolve on its own.
Can someone with aquagenic urticaria drink water?
Some people with aquagenic urticaria can drink water if they keep it off their skin. Even so, a more severe allergy can develop anytime, causing swollen lips and irritation inside the mouth and throat. In the worst cases, anaphylaxis, a life threatening reaction, can occur when drinking water.
How rare is aquagenic urticaria?
Only around 37 cases of aquagenic urticaria have been documented in medical research.
How do you shower with aquagenic urticaria?
If you have aquagenic urticaria, applying a barrier of 100% petroleum jelly to the skin before showering is best. Doctors also recommend short showers and limiting the number of showers. It is best for a person with aquagenic urticaria to determine a showering schedule based on a doctor’s advice because a severe allergic reaction can happen anytime.
What is the life expectancy for aquagenic urticaria?
There are no published studies on life expectancy for those with aquagenic urticaria. That said, the risk of a severe allergic reaction to water is higher in persons without medical evaluation and treatment. Working with your doctor, you can decrease the risk of an allergic reaction and improve your quality of life.