Aquagenic urticaria, also known as water allergy and water urticaria, is a form of physical urticaria in which hives develop on the skin after contact with water, regardless of its temperature.[1] The condition typically results from contact with water of any type, temperature or additive.
| Aquagenic urticaria | |
|---|---|
| Other names | water itch, water allergy |
| Specialty | Dermatology  |
| Symptoms | Hives after skin contact with water |
| Usual onset | Immediate |
| Duration | 30 to 60 minutes |
| Causes | Unclear (triggered by water) |
| Diagnostic method | Based on symptoms, confirmed by "water challenge" test |
| Treatment | Medications, phototherapy, barrier cream |
| Medication | Antihistamines, propranolol, steroids |
Signs and symptoms
editThe main symptom of aquagenic urticaria is the development of physical hives, which may or may not itch. Itching after contact with water, without the development of physical hives, is known as aquagenic pruritus. Aquadynia is a condition in which pain occurs after contact with water.[2]
In severe cases, drinking water can result in swelling of the oral cavity,[3] swelling of the throat,[4] and in extreme cases, anaphylaxis.[5][6][7]
The hives associated with aquagenic urticaria are typically small (approximately 1–3 mm), red- or skin-colored welts (called wheals) with clearly defined edges. It most commonly develops on the neck, upper trunk and arms, although it can occur anywhere on the body. Once the water source is removed, the rash generally fades within 30 to 60 minutes.[8]
Water in all forms, such as tap or sea water, swimming pool water, sweat, tears, and saliva can induce the lesions.[9][10][11]
Cause
editThe cause of aquagenic urticaria is not fully understood; however, several mechanisms have been proposed.[12] Interaction between water and a component in or on the skin or sebum has been suggested. This theory suggests that a substance is formed by this interaction, the absorption of which causes perifollicular mast cell degranulation with release of histamine.[13][14] Another proposed theory is of a water-soluble allergen in the epithelial tissues. Water dissolves the allergen, causing it to diffuse into the tissues, causing histamine release from sensitized mast cells.[15][16]
Diagnosis
editDiagnosis of aquagenic urticaria begins with a clinical history and water challenge test.[17] The water challenge test consists of application of a 35°C water compress to the upper body for 30 minutes. Water of any temperature can provoke aquagenic urticaria; however, keeping the compress at a similar temperature to that of the human body (37 °C) avoids confusion with cold urticaria or cholinergic urticaria. In addition, a forearm or hand can be immersed in water of varying temperatures to determine whether temperature is a factor in the patient's condition. Aquagenic urticaria differs from aquagenic pruritus, in which contact with water evokes intense itching without visible hives or rash.[18][19][20]
Once known as a separate, rare disease, aquagenic urticaria is now considered a subtype of general urticaria.[21] The first case was reported by Walter B Shelley et al. in 1964.[22] The condition is more common in women than men, and typically presents for the first time during puberty. Genetics may play a part, and the condition may be related to other sensitivities such as lactose intolerance.[23][24][25][26][27][13]
Prevention
editDesensitization does not seem to work for aquagenic urticaria; a patient will continue to react to water no matter how gradually or frequently it is introduced.[28] Topical application of antihistamines like 1% diphenhydramine before water exposure is reported to reduce the hives.[29] Oil in water emulsion creams, or petrolatum, applied as barrier agents prior to a shower or bath may control symptoms.[30]
Treatment
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See also
editReferences
edit- ^ NIH. "Aquagenic urticaria". Retrieved 1 March 2020.
- ^ Shelley WB, Shelley E (February 1998). "Aquadynia: Noradrenergic pain induced by bathing and responsive to clonidine". Journal of the American Academy of Dermatology. 38 (2): 357–358. doi:10.1016/s0190-9622(98)70583-3. ISSN 0190-9622. PMID 9486716.
- ^ Seol JE, Kim DH, Park SH, Kang JN, Sung HS, Kim H (June 2017). "Aquagenic Urticaria Diagnosed by the Water Provocation Test and the Results of Histopathologic Examination". Annals of Dermatology. 29 (3): 341–345. doi:10.5021/ad.2017.29.3.341. PMC 5438944. PMID 28566914.
- ^ "The woman who is allergic to water".
- ^ "JUST ONE CUP OF WATER COULD KILL LITTLE HEIDI; Girl's deadly allergy means she cannot weep, wash, drink, play or even stand in the rain. - Free Online Library".
- ^ "Girl allergic to water". 14 December 2018.
- ^ "Here's What Happens when You Develop an Allergy to Water". 15 December 2015.
- ^ Park H, Kim HS, Yoo DS, Kim JW, Kim CW, Kim SS, Hwang JI, Lee JY, Choi YJ (2011). "Aquagenic urticaria: A report of two cases". Annals of Dermatology. 23 (Suppl 3): S371–4. doi:10.5021/ad.2011.23.S3.S371. PMC 3276800. PMID 22346281.
- ^ Sibbald RG, Black AK, Eady RA, James M, Greaves MW (1981). "Aquagenic urticaria: Evidence of cholinergic and histaminergic basis". The British Journal of Dermatology. 105 (3): 297–302. doi:10.1111/j.1365-2133.1981.tb01289.x. PMID 7272209. S2CID 37931708.
- ^ Harwood CA, Kobza-Black A (1992). "Aquagenic urticaria masquerading as occupational penicillin allergy". The British Journal of Dermatology. 127 (5): 547–8. doi:10.1111/j.1365-2133.1992.tb14862.x. PMID 1467303. S2CID 27755086.
- ^ Martínez-Escribano JA, Quecedo E, de la Cuadra J, Frías J, Sánchez-Pedreño P, Aliaga A (1997). "Treatment of aquagenic urticaria with PUVA and astemizole". Journal of the American Academy of Dermatology. 36 (1): 118–9. doi:10.1016/s0190-9622(97)70344-x. PMID 8996279.
- ^ Lee HG, Lee AY, Lee YS (1990). "A case of aquagenic urticaria". Korean J Dermatol. 28: 456–458.
- ^ a b Shelley WB, Rawnsley HM (1964). "Aquagenic Urticaria. Contact Sensitivity Reaction to Water". JAMA. 189: 895–8. doi:10.1001/jama.1964.03070120017003. PMID 14172902.
- ^ Rothbaum R, McGee JS (2016). "Aquagenic urticaria: diagnostic and management challenges". Journal of Asthma and Allergy. 9: 209–213. doi:10.2147/JAA.S91505. ISSN 1178-6965. PMC 5136360. PMID 27942227.
- ^ Rothbaum R, McGee JS (29 November 2016). "Aquagenic urticaria: Diagnostic and management challenges". Journal of Asthma and Allergy. 9: 209–213. doi:10.2147/JAA.S91505. PMC 5136360. PMID 27942227.
- ^ Barbaud A (May 2003). "[Physical urticarias]". Annales de Dermatologie et de Venereologie. 130: 1S16–27. PMID 12843805.
- ^ Dice JP (2004). "Physical urticaria". Immunology and Allergy Clinics of North America. 24 (2): 225–46, vi. doi:10.1016/j.iac.2004.01.005. PMID 15120149.
- ^ Panconesi E, Lotti T (1987). "Aquagenic urticaria". Clinics in Dermatology. 5 (3): 49–51. doi:10.1016/s0738-081x(87)80008-1. PMID 3664423.
- ^ Rothbaum R, McGee JS (2016-11-29). "Aquagenic urticaria: diagnostic and management challenges". Journal of Asthma and Allergy. 9: 209–213. doi:10.2147/JAA.S91505. PMC 5136360. PMID 27942227.
- ^ Casale TB, Olsen JA, DelasAlas HC (May 2013). "Aquagenic Urticaria". The Journal of Allergy and Clinical Immunology: In Practice. 1 (3): 295–296. doi:10.1016/j.jaip.2013.02.003. ISSN 2213-2198. PMID 24565488.
- ^ Beaven MA (2009). "Our perception of the mast cell from Paul Ehrlich to now". European Journal of Immunology. 39 (1): 11–25. doi:10.1002/eji.200838899. PMC 2950100. PMID 19130582.
- ^ Zuberbier T, Asero R, Bindslev-Jensen C, Walter Canonica G, Church MK, Giménez-Arnau A, Grattan CE, Kapp A, Merk HF, Rogala B, Saini S, Sánchez-Borges M, Schmid-Grendelmeier P, Schünemann H, Staubach P, Vena GA, Wedi B, Maurer M, Dermatology Section of the European Academy of Allergology Clinical Immunology., Global Allergy Asthma European Network. (2009). "EAACI/GA(2)LEN/EDF/WAO guideline: Definition, classification and diagnosis of urticaria". Allergy. 64 (10): 1417–26. doi:10.1111/j.1398-9995.2009.02179.x. PMID 19772512. S2CID 21174848.
- ^ Yavuz ST, Sahiner UM, Tuncer A, Sackesen C (2010). "Aquagenic urticaria in 2 adolescents". Journal of Investigational Allergology & Clinical Immunology. 20 (7): 624–5. PMID 21314009.
- ^ Pitarch G, Torrijos A, Martínez-Menchón T, Sánchez-Carazo JL, Fortea JM (2006). "Familial aquagenic urticaria and bernard-soulier syndrome". Dermatology. 212 (1): 96–7. doi:10.1159/000089035. PMID 16319487. S2CID 43153639.
- ^ Baptist AP, Baldwin JL (2005). "Aquagenic urticaria with extracutaneous manifestations". Allergy and Asthma Proceedings. 26 (3): 217–20. PMID 16119038.
- ^ Park H, Kim HS, Yoo DS, Kim JW, Kim CW, Kim SS, Hwang JI, Lee JY, Choi YJ (2011). "Aquagenic urticaria: A report of two cases". Annals of Dermatology. 23 (Suppl 3): S371–4. doi:10.5021/ad.2011.23.S3.S371. PMC 3276800. PMID 22346281.
- ^ Treudler R, Tebbe B, Steinhoff M, Orfanos CE (2002). "Familial aquagenic urticaria associated with familial lactose intolerance". Journal of the American Academy of Dermatology. 47 (4): 611–3. doi:10.1067/mjd.2002.124599. PMID 12271310.
- ^ Frances AM, Fiorenza G, Frances RJ (2004). "Aquagenic urticaria: Report of a case". Allergy and Asthma Proceedings. 25 (3): 195–7. PMID 15317326.
- ^ Hide M, Yamamura Y, Sanada S, Yamamoto S (2000). "Aquagenic urticaria: A case report". Acta Dermato-Venereologica. 80 (2): 148–9. doi:10.2340/0001555580150. PMID 10877142. S2CID 29448803.
- ^ Wong E, Eftekhari N, Greaves MW, Ward AM (1987). "Beneficial effects of danazol on symptoms and laboratory changes in cholinergic urticaria". The British Journal of Dermatology. 116 (4): 553–6. doi:10.1111/j.1365-2133.1987.tb05877.x. PMID 3555598. S2CID 46181271.