Water Allergy or Aquagenic urticaria is a hive-like rash that develops after exposure to water. It is considered to be a rare condition but a number of people report in forums to having some sensitivity to water on their skin. It seems crazy to be allergic to something so vital to our bodies but medical literature has documented a number of these types of cases. The defining symptom is a painful skin reaction resulting from contact with water. This may also be the effect of different temperatures of water, such as cold or hot, and can flare with chemicals such as fluorine and chlorine. People with this condition must avoid getting caught out in the rain and can only take quick showers lasting seconds.
Causes
Symptoms of aquagenic urticaria can occur after bathing, swimming, or walking in the rain. In some cases the skin may even break out when they sweat or emit tears. The solvents in the water or the temperature do not appear to influence the aquagenic urticaria reaction.
Lactose intolerance appears to increase the risk of developing aquagenic urticaria. A familial pattern appears to coexist due to this disease’s location on chromosome 2q21.
Females that have siblings that suffer from Bernard Soulier syndrome appear to have a significantly higher chance of developing aquagenic urticaria. This disease increases bleeding time by altering the body’s platelet count. This disease appears to be caused by a mutation on chromosome 3 which damages the body’s von Willebrand factor receptor.
Diseases such as polymorphous, atopy, cholinergic urticarial, light eruption, HIV infection as well as Bernard-Soulier syndrome appear to have a correlation with the appearance of aquagenic urticaria as well.
Symptoms
The skin will itch or burn after you expose yourself to water. Within 1 to 15 minutes of this exposure hives, rash or erythema may appear. Within 10-120 minutes lesions may develop which can be quite painful. In some cases difficulty swallowing, wheezing or subjective respiratory distress will occur after drinking water.
Treatment
Life avoiding water can be pretty difficult. Crying causes pain and stinging from water on the face. Going for a swim is out of the question. In some severe cases, drinking water based beverages can cause swelling of the lips and tongue. A thorough work-up, including blood work and skin testing, will be performed on a person complaining of skin rashes from exposure to water.
- Oral antihistamine– Antihistamines such as hydrochloride, hydroxyzine, terfenadine and cyproheptadine have frequently been used to reverse or minimize the effects of aquagenic urticaria. The therapeutic response to these medications will vary from patient to patient and the benefits of applying a histamine antagonist to the skin has not been found to create a direct link to the minimization of water based urticaria effects.
- Topical corticosteroids– Parenteral corticosteroids have been used to help treat aquagenic uricaria in the past. The actual effect of this medication and its benefits are not clear at this time.
- Epinephrine– Patients with severe bouts of urticarial that appear to be acute will frequently use this medication to help decrease the appearance of cutaneous vasodilation. This can also help inhibit mast cell degranulation which may contribute to the presence of aquagenic urticaria.
- PUVA therapy– In one test a 21 year old woman was given PUVA therapy four times a week in increased doses to help manage the symptoms of aquagenic urticaria. As the dosage was increased the lesions and itching caused by the disease disappeared.
- Ultraviolet radiation– Radiation is commonly used alongside antihistamines to help rid the patient of lesions and outbreaks caused by aquagenic urticaria. This therapy will cause thickening of the epidermis which can prevent water from penetrating this layer and interacting with the cells underneath. Ultraviolet therapy may also cause mast cells to limit their response to stimuli and immunosuppression which can help prevent these reactions.
- Stanazolol– Treatments for the human immunodeficiency virus or HIV have been found to help with the symptoms of Aqugenic Urticaria as well.
- Capsaicin – This medication is often used for producing Zostrix, a cream applied to lessen pain that caused by aquagenic urticaria.
- Barrier methods– In some circumstances and oil in water solution or emulsion cream can be applied to the skin to protect it from water exposure while washing or performing aquatic activities. There does not appear to be a side effect to this method and the application is easier than many other options. Doctors will also recommend that these patients use physical barriers such as an umbrella or protective clothing to avoid contact with water to protect patients from potential outbreaks. Activities such as swimming or visiting a water park will also need to be avoided to minimize the risk of an outbreak.
