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Aquagenic Urticaria, colloquially known as water allergy, is a rare and relatively unknown form of urticaria. This condition occurs when an individual's skin comes into contact with water, irrespective of its temperature.
The name may be misleading as it's not a true allergy, but rather a hypersensitivity to the ions found in non-distilled water. This condition is a form of physical urticaria, which refers to a group of disorders where physical stimuli induce hives.
The precise pathogenesis of Aquagenic Urticaria remains a mystery, and numerous theories have been proposed to explain its occurrence. Some theories suggest that it could be an allergen or chemical in the water that triggers the reaction. Others propose that water interacts with unknown components of the skin, leading to the release of histamine from mast cells and the formation of an urticarial rash.
In Aquagenic Urticaria, all types of water can trigger an urticarial reaction, including still or running fresh water, rainwater, or tap water. It can also be evoked by contact with sweat, tears, saliva, rain, and snow. The reaction is not affected by water temperature, saltiness, or pH, and does not depend on psychogenic factors.
Aquagenic Urticaria shows a higher prevalence among females, with the typical age of onset occurring during or after puberty. Most cases have occurred sporadically, but several familial cases have also been reported.
Skin contact with water causes symptoms within 20 to 30 minutes. These symptoms include redness, erythema, intense itching, and small perifollicular swellings (wheals) surrounded by erythematous flares. In severe cases, Aquagenic Urticaria can cause systemic symptoms, such as shortness of breath and wheezing.
Diagnosis of Aquagenic Urticaria is usually based on the symptoms reported by the patient. Confirmation can be done through a provocation test. This test involves applying a cloth moistened with water at room temperature to the skin for approximately 20 minutes. If the patient develops urticaria, the diagnosis is confirmed.
Despite the impracticality of avoiding water, patients are often advised to avoid triggers. Pharmacological treatment is necessary to prevent or minimize the symptoms induced by contact with water. Often, doctors recommend a therapy based on antihistamines active on H1 histaminergic receptors. If oral antihistamines and topical treatments are not effective, there are other options such as Phototherapy, Acetylcholine antagonists, Omalizumab, Steroid drugs, and Selective serotonin reuptake inhibitors (SSRIs).
Living with Aquagenic Urticaria can be challenging, as it can limit daily activities like bathing or going out in the rain. However, with the right treatment and advice from an allergist or dermatologist, individuals with this condition can manage their symptoms and lead a normal life.
Understanding Aquagenic Urticaria is crucial, not just for those affected but also for their families, friends, and caregivers. As we continue to explore and research this rare condition, we hope to find more effective treatments and, ultimately, a cure.