Aquagenic urticaria

Aquagenic urticaria
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Synonyms	itchy rash from contact with water
Pronounce
Field
Symptoms	Itchy red hives
Complications
Onset	Around puberty
Duration	30 to 60 minutes
Types
Causes	Unclear (triggered by water)
Risks
Diagnosis	Based on symptoms, confirmed by "water challenge" test
Differential diagnosis
Prevention
Treatment	Medications, phototherapy, barrier cream
Medication	Antihistamines, propranolol, steroids
Prognosis
Frequency
Deaths

Aquagenic urticaria, also known as water allergy or water urticaria, is a rare physical form of urticaria<ref name=NIH2018/><ref name="autogechickennerated1">"Physical urticarias". www.uptodate.com. UpToDate, Inc. March 31, 2016. Retrieved 2016-10-14.</ref>. This condition is characterized by an itchy skin reaction upon contact with water, regardless of its temperature.<ref name=NIH2018/> Although sometimes referred to as an allergy, it does not involve a histamine-releasing allergic reaction like other forms of urticaria. Importantly, this response seems to be independent of the water's temperature or any dissolved chemicals, as it can also occur with distilled water and medical saline.<ref name="autogechickennerated1" />

Clinical Manifestations

Aquagenic urticaria presents with symptoms similar to those of other types of physical hives. This includes wheals or small raised hives, intense itching, and skin flushing, especially in areas exposed to water. These symptoms can appear within minutes following water contact<ref>Dice JP & Gonzalez-Reyes E. Physical urticarias. UpToDate. March, 2016</ref>. The hives, or urticaria, associated with this condition are typically small (1–3 mm), red or skin-colored welts (wheals) with defined edges. The rash predominantly affects the neck, upper trunk, and arms, but can occur anywhere on the body. Upon removal of the water source, the rash typically subsides within 30 to 60 minutes.<ref>,

 Aquagenic urticaria: A report of two cases, 
 Annals of Dermatology, 
 2011,
 Vol. 23(Issue: Suppl 3),
 pp. S371–4,
 DOI: 10.5021/ad.2011.23.S3.S371,
 PMID: 22346281,
 PMC: 3276800,</ref>.

Etiology

The exact etiology of aquagenic urticaria remains unclear<ref>Rothbaum, Robert,

 Aquagenic urticaria: diagnostic and management challenges, 
 Journal of Asthma and Allergy, 
 
 Vol. 9,
 pp. 209–213,
 DOI: 10.2147/JAA.S91505,
 PMID: 27942227,
 PMC: 5136360,</ref>. Current hypotheses suggest that the immune response may be triggered by tiny quantities of an unknown substance in the water, or by the water interacting with a substance on or within the skin<ref name=NIH2018>

Aquagenic urticaria(link). Genetic and Rare Diseases Information Center.

20 June

User continue ChatGPT 2016.

Accessed 2018-02-27.

</ref>. Although it is often referred to as a water allergy, this is a misnomer, as this condition does not represent a true allergy to water, particularly given the large proportion of water in the human body.

Diagnosis

Diagnosis of aquagenic urticaria typically commences with an evaluation of the patient's medical history to identify any potential triggers for the observed symptoms. This is often followed by a water challenge test, in which water is applied to the upper body for a duration of 30 minutes. The water may be applied directly or a water-soaked paper towel may be used. The test often involves distilled water, tap water, and saline to investigate any differences in the reaction. Following removal of the water, the skin is observed for a reaction for the next 10–15 minutes<ref name="md-health1">

Aquagenic Urticaria(link). {{{website}}}. MD-Health.com.

</ref>.

Given that aquagenic urticaria frequently coexists with other forms of physical urticaria, additional tests may be conducted to check for these conditions. An ice cube may be placed on the forearm to test for cold urticaria, while exposure to a hot bath may be used to test for cholinergic urticaria. Furthermore, lesions, if present, will be inspected to identify potential underlying causes of their appearance<ref name="md-health1"/>.

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