What Is Aquagenic Urticaria?

Medically Reviewed by Stephanie S. Gardner, MD on June 08, 2024
Written by Irene Lopez
5 min read

Water is an essential part of our lives, and for most people, it’s harmless. A rare disease called aquagenic urticaria, though, can make it difficult for some people to come in contact with water. Here’s what you need to know about this medical condition.

Aquagenic urticaria is a rare type of physical urticaria. With physical urticaria, people can get reddish-colored or skin-colored raised skin rashes called hives and itching when the skin comes in contact with hot or cold temperatures, chemicals, or plants.

When they manifest the aquagenic form of urticaria, people develop hives and sometimes itching when their skin encounters water. The hives are about 1 to 3 mm in size with clearly defined edges. The symptoms can show up anywhere on the body, but they are more commonly seen on the neck, the upper part of the torso, and the arms.

The water that can trigger a reaction includes the water you find in rain and snow, as well as the water found in your sweat and tears. The temperature of the water doesn’t make any difference to how the condition develops.

People who have the condition can drink water as long as it doesn’t touch their skin, but some people can have a reaction when the water comes into contact with their lips or the inside of their mouth.

Aquagenic urticaria can affect any gender, but it is seen more commonly in women. The symptoms can start with puberty or after puberty starts.

Talk to an allergist or dermatologist about treatment options. Allergists, also called immunologists, are specialized in treating allergies. Dermatologists diagnose and treat conditions of the skin, hair, and nails. 

Treatment can help make it easier to take a shower, but treatments may not be as effective for some people. Those affected may have to cut down on how much or how often they shower. They may also need to cut down on water-based activities.

Hives can start within 30 minutes of contact with water. Sometimes, there may be itching. More rarely, there may be wheezing (breathing with a coarse, whistling sound) or difficulties breathing.  

The symptoms usually wear off on their own once the water source has been removed. It can take anywhere from 30 minutes to 2 hours for symptoms to fade.

It’s unclear what causes aquagenic urticaria. Studies are still being carried out to find out why it happens to some people. 

Scientists have put forward a few theories in recent years, though.

  • Material dissolved in water passes through the skin and causes an allergic reaction. So, the hives are caused by the material, called an allergen, that is in the water and not the water itself. 
  • The allergic reaction may be caused by the water coming in contact with a substance that’s in or on the skin.

Because the condition is rare and we don’t have much information on how effective the treatments are, there isn’t much that can be shared in terms of aquagenic urticaria facts. 

Your allergist or dermatologist will diagnose the condition based on the symptoms that are being reported. Additionally, your doctor will conduct what's known as a "water challenge test" to confirm a diagnosis.

A cloth that's been dampened with water at room temperature will be applied to your skin for 20 minutes. Your doctor will then keep a close watch for symptoms of allergic reactions. The cloth is usually placed on the upper half of your body because symptoms are more common in this region.

There is no cure for aquagenic urticaria at this time. The ideal form of treatment is to avoid water completely, but this isn’t a practical solution for people who have this condition. Instead, your doctor will suggest aquagenic urticaria treatments and medications to help you cope better with being exposed to water.

  • Antihistamines. The preferred first-line aquagenic urticaria treatment protocol is oral (taken through the mouth) H1 antihistamines, a class of drugs used to treat allergies.

It has been determined, though, that first-generation antihistamines have undesirable side effects like sleepiness that can last longer than the benefits provided by the medication. Consequently, doctors prefer to use second-generation antihistamines, although there is no conclusive proof that this treatment is effective in the case of aquagenic urticaria. Information that is available suggests that oral antihistamines on their own may not be a sufficient way to treat the condition.

  • Topical medication. Topical medication is a form of medication that’s applied to the body and absorbed through the skin. Oil-based emulsions (a lighter form of moisturizer) and creams that contain a substance called petrolatum have been seen to reduce or remove symptoms in some patients. Your doctor may prefer to try topical medication first for children to avoid the side effects of antihistamines.
  • Phototherapy. Sometimes, even after trying both oral and topical medication, you may not get good results. Some patients have seen improvements after using phototherapy. In phototherapy, UV or ultraviolet light is used to treat certain medical conditions.

Specific types of radiation, such as psoralens ultraviolet radiation A and ultraviolet radiation B, have been effective in treating some cases of aquagenic urticaria. The radiation A form has also worked well in a few cases when combined with antihistamines.

  • Other treatments. Steroid medication such as Stanozolol has demonstrated effectiveness in a few cases, but the medication has major side effects. A class of drugs called SSRIs (Selective Serotonin Reuptake Inhibitors) has also been correlated with positive results. SSRIs are usually used to treat depression and other mental health conditions. 

A medication called Omalizumab may help in some cases. Omalizumab is usually used to treat severe forms of asthma and hives. 

Your doctor will review your case history and symptoms and recommend treatment options suitable for you. 

Connect with local or online support or advocacy groups. These groups can help connect you with others who have the same condition. They can also guide you toward further research and helpful resources.

It can be a challenge to live with a condition like aquagenic urticaria. Although there is no cure at this time, treatments can help minimize the challenges of dealing with this condition. Research is ongoing, and as more information becomes available, better treatments may become available in the future.