Is There a Cure for Aquagenic Urticaria?

The underlying cause of aquagenic urticaria is unknown. In some cases, it is a symptom of polycythemia vera or another underlying condition. Proposed, plausible underlying causes of aquagenic pruritus include

• Increased mast cell degranulation: Releasing granules rich in histamine and other compounds into the body by mast cells, a special type of cell that plays a role in allergies and priming of the immune system.
• Increased circulating histamine: A chemical responsible for reactions.
• Release of acetylcholine: A chemical in the body that sends signals from nerves to muscles and other nerves in the brain.
• Increased skin fibrinolytic activity: An activity that controls clot size by promoting the breakdown of blood clots.

Aquagenic urticaria is a rare condition that can cause an itchy, painful rash. This rash commonly appears on the neck, arms and chest, but hives can appear anywhere on the body. Within minutes of being exposed to water, people with this condition can experience

• Erythema or reddening of the skin
• Burning sensations
• Lesions
• Inflammation

In more severe cases, drinking water can cause symptoms, including

• Rash around the mouth
• Difficulty swallowing
• Wheezing
• Difficulty breathing

There is no specific exam that confirms a diagnosis of aquagenic pruritus. The diagnosis is generally made by ruling out other conditions. The following criteria may help make the diagnosis:

• Severe itching (could be the only symptom), prickling, stinging or burning that consistently develops after the skin has been in contact with water, regardless of water temperature or salinity.
• Lack of visible skin manifestations.
• Reaction within minutes of exposure and lasting anywhere between 10 minutes to two hours.
• Lack of another skin disease, underlying condition or medication to account for the reaction.

Treatment involves medication and lifestyle modifications.

• Oral medications
  • Antihistamines
  • Analgesics (pain relievers)
  • Opioid receptor antagonists, such as naltrexone
  • Alpha interferon-2b
  • Cholestyramine (used for lowering cholesterol)
  • Clonidine (used for high blood pressure)
  • Selective serotonin reuptake inhibitors
  • Beta-blockers (propranolol, atenolol)
• Adding sodium bicarbonate to bath water
• Different types of phototherapies (could be up to 50 percent effective)
• Topical creams and ointments containing corticosteroid or capsaicin
• Transcutaneous electrical nerve stimulation (TENS)