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Aquagenic Urticaria or Water Allergy: Causes, Symptoms, Treatment, Risk Factors

What Is Aquagenic Urticaria or Water Allergy?

Aquagenic urticaria or water allergy (being allergic to water) is a typical form of physical hives that is caused when the person comes in contact with the water. This may often be associated with pain and itchiness. This may appear without any external agents or due to the water temperature. Aquagenic urticaria or water allergy is found more in women as compared to men. However, even juvenile patients have increased chances of being affected by the condition. The kids who are in their age of puberty often have the tendency to develop such symptoms and become noticeable as well.

Aquagenic Urticaria or Water Allergy

The other names of Aquagenic Urticaria are Water Urticaria or Water Hives. It might seem a little vague to some people that someone can be allergic to water when water occupies the maximum space in our body. Nevertheless, there are evidences recorded in the medical journals about the occurrence of people being allergic to water.

The hives may appear within a minute or after fifteen minutes when a person comes in contact with the water. It can last for a brief period of 10 minutes and can last up to 120 minutes. The ones that last for a long time are not seemingly stimulated by histamine discharges. People who are suffering from Aquagenic urticaria or water allergy (being allergic to water) can safely consume water, but may develop allergies in and around the mouth.

What Are The Causes of Aquagenic Urticaria or Water Allergy?

The exact cause of Aquagenic urticaria or water allergy (being allergic to water) has not been known and some doctors say that it may develop in patients with a hypersensitive immune system who are in contact with allergy triggers. Some of the theories that develop such allergies are:

  • Sensitivity to various chemical additives in the water. This may include chemicals, chlorine and hard water.
  • The skin mast cells that are weakened might interfere with water to give a skin sensation.

While the exact cause of aquagenic reactions may not be known, they do know that burning, itching and flushing might be the related problems. Release of histamine often causes a burning sensation and itching in the skin. This is majorly caused due to the reaction of tissues with the surrounding water.

  • Symptoms of Aquagenic urticaria or water allergy may be witnessed after swimming or walking in the rain. Sometimes, the skin can break out when the body sweats or a person cries. The temperature and the water solvents do not seem to cause the reaction.
  • People who are lactose intolerant often have the highest risk of developing Aquagenic urticaria or water allergy (being allergic to water). As the disease in located on chromosome 2q21, there is a significant pattern observed in its occurrence.
  • Females who have an heir of Bernard Soulier syndrome sufferers may have a higher chance of developing Aquagenic urticaria or water allergy (being allergic to water). The bleeding time is significantly increased as the disease alters the platelet count in the blood. The ailment can also be caused by chromosome 3 mutation which is known to damage the receptor of Von Willebrand factor in the body.
  • Diseases like Bernard-Soulier syndrome, light eruption, HIV infection, atopy, cholinergic urticaria and polymorphous correlate with the aquagenic urticaria appearance.

Risk Factors for Aquagenic Urticaria or Water Allergy

  • Familiar Lactose Intolerance: Aquagenic urticaria shares a coincidental relation with the lactose intolerant people and may also be associated with the gene loci and the family heir. The gene that is a carrier of such disorder is Chromosome 2q21 and it is responsible for the production of lactase enzyme that is absent in lactose intolerant people.
  • Bernard-Soulier Syndrome: The female kin who are sufferers of aquagenic urticaria and Bernard-Soulier syndrome, may be prone to get affected by Aquagenic urticaria or water allergy easily.

Signs and Symptoms of Aquagenic Urticaria or Water Allergy

The symptoms of Aquagenic urticaria or water allergy (being allergic to water) are similar to all the other types of physical hives that are caused by various things. This may include wheals or small raised hives, intense itching, skin flushing in the areas that are prone to water contact. The symptoms may appear within minutes after the body comes in contact with the water.

The rashes will subside when the body does not come in contact with the water. The hives may last for a few hours after the reaction appears on the skin but it is quite uncommon in people who are suffering from such diseases.

Tests to Diagnose Aquagenic Urticaria or Water Allergy

Aquagenic urticaria or water allergy (being allergic to water) may be diagnosed by evaluating the clinical history of a patient. The signs may cause severe reaction and the patient will be subjected to water for occurrence of symptoms. The test will then be conducted on the part where the water has been applied. In some cases, distilled, saline and tap water may be used to see various reactions.

The symptoms of aquagenic urticaria or water allergy will be similar to the physical hives that appear after the test has been conducted. To evaluate cold urticarial, an ice cube may be placed by the doctor on the forearm and Cholinergic urticaria will be evaluated by exposing the body to hot water. The root cause of the appearance of such symptoms might be due to the lesions and they will be inspected as well.

Treatment for Aquagenic Urticaria or Water Allergy

The right treatment for getting rid of the aquagenic urticaria symptoms or water allergy symptoms has not been determined. Many treatments are used to bring down the symptoms of being allergic to water render an unusual comfort to the body.

  • Antihistamines to Treat Aquagenic Urticaria or Water Allergy: Antihistamines like cyproheptadine, terfenadine, hydrochloride and hydroxyzine may be used for minimizing the symptoms. The response of such medications may vary and the association of histamine antagonist application on the skin has not been identified.
  • Corticosteroids For Treating Allergy To Water: In the past, the symptoms of aquagenic urticaria were treated using parenteral corticosteroids and the benefits that come along with their use have not been speculated.
  • Psoralen/Ultraviolet A (PUVA) Therapy for Aquagenic Urticaria or Water Allergy: There are evidences of using this therapy for bringing down the symptoms associated with aquagenic urticaria or water allergy. With the increasing dosages, the lesions were significantly reduced and eventually disappeared.
  • Ultraviolet Therapy for Treatment of Allergy to Water: A combination of antihistamines and radiation is used commonly for treating the skin outbreaks and lesions arising from water allergy in a tremendous way. The epidermis will be thickened with this type of treatment as the radiations will penetrate deep inside the skin to a cellular level. This may cause the suppression of mast cells that cause the disease and skin lesions. The response of the cells to its stimuli is reduced, which helps in controlling the symptoms of aquagenic urticaria or water allergy in an unusual way.
  • Epinephrine: Acute and severe sessions of urticaria can be treated using epinephrine and brings down the symptoms in an unusual way. This can also slower down the degranulation of mast cells that contribute aquagenic urticaria.
  • Stanazolol: The Aquagenic Urticaria or water allergy symptoms can be treated with the HIV or human immunodeficiency virus treatments.
  • Capsaicin: Zostrix an ointment produced using capsaicin is used for lessening the pain caused by the disease.

In some cases, an emulsion of oil and water in the form of a cream can be used on the skin to avoid its contact with water when a person indulges in various activities that are related to water. However, doctors have not found any side effects that are caused by the application of such mixtures. At times, a patient may also be suggested to use a barrier like swimming gears or umbrellas to avoid skin breakouts when it comes in contact with the water. Swimming and visiting a water arena will also have to be limited when a person is getting treated for aquagenic urticaria or water allergy. All the precautions will be asked to follow by the patient when in need. The doctor might also prescribe:

  • Water-resistant sun block
  • Emollients
  • Anticholinergics
  • Oil-in-water emulsion skin cream
  • Selective serotonin reuptake inhibitors (SSRI)

Coping with Aquagenic Urticaria or Water Allergy

Avoiding water can be difficult at times and a person who is allergic to water can only take a shower for a few seconds. They also have to avoid coming in contact with water to avoid breaking out of the skin. The lesions that are developed due to crying may be painful or cause a tingling sensation on the face. In some cases, consumption of beverages and water may result in swelling of the tongue and lips.

Lifestyle Changes for Aquagenic Urticaria or Water Allergy

If you are experiencing angioedema or mild hives as a result of being allergic to water, the following tips may prove to be helpful:

  • Try to stay away from the triggers. Such triggers may include rain, pet dander, stings of insects, foods and latex.
  • Wear smooth textured cotton clothes that are loose to avoid skin irritation. Tight or uneasy clothes that are woolen made may cause irritation. Try to avoid them.
  • Modify the diet plan and include medication: Some conditions that are associated with aquagenic urticaria may develop when the allergens are consumed. Restricting the consumption of certain foods and low histamine diets may be beneficial. Eggs, dairy products and wheat may be counted amongst common allergens, so they should be avoided as well. Check with the doctor for finding a list of deficient vitamins in the body and take necessary medications.
  • Try covering the areas that are affected with a bandage to avoid their contact with water for a long time.


  1. Byrd, A. L., et al. (2020). Aquagenic Urticaria: A Rare Water-Induced Physical Urticaria. Cureus, 12(8), e10129. https://doi.org/10.7759/cureus.10129

  2. Grattan, C. E. H. (2017). Aquagenic Urticaria. Clinical and Experimental Dermatology, 42(6), 595–598. https://doi.org/10.1111/ced.13053

  3. Bailey, E. (2019). Aquagenic Urticaria. DermNet NZ. https://dermnetnz.org/topics/aquagenic-urticaria/

  4. O’Grady, J. T., et al. (2021). Aquagenic Urticaria Treated with Psoralen/Ultraviolet A (PUVA) Therapy: A Case Report and Literature Review. Case Reports in Dermatology, 13(1), 1–6. https://doi.org/10.1159/000512098

Team PainAssist
Team PainAssist
Written, Edited or Reviewed By: Team PainAssist, Pain Assist Inc. This article does not provide medical advice. See disclaimer
Last Modified On:August 24, 2023

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