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All living beings depend on water to live. As far as humans are concerned, the human brain and heart are roughly 70% water, while the lungs contain a whopping 80%. Even bones are about 30% water. To survive, we need an average of about 2,4 liters per day, part of which we get from food. But what happens if there is an allergy to water? This applies to the few who have a condition called aquagenic urticaria. A water allergy means that ordinary water that comes into contact with the body causes a sharp reaction of the immune system.
People with this extremely rare condition limit certain fruits and vegetables that are high in water content and often prefer to drink diet soft drinks instead of tea, coffee, or juice. In addition to diet, a person suffering from aquatic urticaria must control a number of natural biological processes, such as sweating and tears, plus minimizing exposure to rain and damp conditions to avoid hives, swelling, and pain.
Can adults be allergic to water
The first case of aquagenic urticaria was reported in 1963, when a 15-year-old girl developed ulcers after water skiing. It was subsequently defined as severe water sensitivity, manifesting as itchy blisters on exposed skin within minutes.
This condition is more common in women and likely begins to develop during puberty, with a genetic predisposition being the most likely cause. Its rarity means the condition is often misdiagnosed as an allergy to chemicals in the water, such as chlorine or salt. The inflammation can last an hour or longer and can lead to patients developing a phobia of swimming in the water. In severe cases, anaphylactic shock may develop.
Less than a hundred case studies have been found in the medical literature linking this condition to other serious diseases such as T-cell non-Hodgkin’s lymphoma and hepatitis C infections. The lack of research into treatment and diagnosis makes it difficult to identify the condition, but antihistamines have been proven to work in some people. Fortunately, it is determined that the condition does not worsen as the patient gets older, and sometimes completely disappears.
How does water allergy manifest in adults?
Aquagenic urticaria is a rare condition in which people develop an allergic reaction to water after it comes into contact with the skin. People with aquatic urticaria can drink water, but they may have an allergic reaction when swimming or showering, sweating, crying, or raining. Urticaria and blisters may develop on the part of the skin that comes into direct contact with water.
Urticaria (a type of itchy rash) develops quickly after skin contact with water, including sweat or tears. The condition only occurs through skin contact, so people with aquagenic urticaria are not at risk of dehydration.
Symptoms develop very quickly. As soon as people come into contact with water, they get itchy hives. It has the appearance of blisters, bulges on the skin, without the formation of blisters with liquid. After the skin dries, they usually fade within 30 to 60 minutes.
In more severe cases, this condition can also cause angioedema, swelling of tissues under the skin. This is a deeper lesion than hives and may be more painful. Both urticaria and angioedema tend to develop on contact with water of any temperature.
Although aquagenic urticaria resembles an allergy, technically it is not – it is a so-called pseudo-allergy. The mechanisms causing this disease are not true allergic mechanisms.
Because of this, medications that work for allergies, such as microdosed allergen shots that are given to a patient to stimulate their immune system and build tolerance, are not completely effective. While antihistamines may help by slightly relieving the symptoms of hives, the best thing patients can do is avoid contact with water.
In addition, aquagenic urticaria provokes serious stress. Although reactions vary, most patients experience them every day, several times a day. And patients worry about it. Studies have shown that patients with all types of chronic urticaria, including aquagenic urticaria, have higher levels of depression and anxiety. Even eating and drinking can be stressful because if water gets on the skin or spicy food makes the patient sweat, they will have an allergic reaction.
How to treat water allergy in adults
Most cases of aquatic urticaria occur in people who do not have a family history of aquatic urticaria. However, familial cases have been reported several times, with one report describing the disease in three generations of the same family. There is also an association with other conditions, some of which may be familial. Therefore, it is important to exclude all other diseases, and only then treat the water allergy.
Diagnostics
The diagnosis of aquagenic urticaria is usually suspected based on characteristic signs and symptoms. A water splash test may then be ordered to confirm the diagnosis. During this test, a 35°C water compress is applied to the upper body for 30 minutes. The upper body was chosen as the preferred site for the test because other areas, such as the legs, are less commonly affected. It is important to tell the patient not to take antihistamines for several days before the test.
In some cases, you need to rinse certain areas of the body with water or take a direct bath and shower. The use of these tests may be required when a conventional water stimulus test using a small water compress is negative, although patients report symptoms of urticaria.
Modern methods
Due to the rarity of aquatic urticaria, data on the effectiveness of individual treatments is very limited. To date, no large-scale studies have been conducted. Unlike other types of physical urticaria, where exposure can be avoided, avoiding water exposure is extremely difficult. Doctors use the following methods of treatment:
Antihistamines – they are usually used as first line therapy for all forms of urticaria. Those that block H1 receptors (H1 antihistamines) and are not sedating, such as cetirizine, are preferred. Other H1 antihistamines (such as hydroxyzine) or H2 antihistamines (such as cimetidine) may be given if H1 antihistamines are ineffective.
Creams or other topical products – they serve as a barrier between water and skin, such as products based on petrolatum. They can be used before bathing or other water exposure to prevent water from reaching the skin.
Phototherapy – there is evidence that ultraviolet light therapy (also called phototherapy), such as ultraviolet A (PUV-A) and ultraviolet B, relieves allergy symptoms in some cases.
Omalizumab An injectable medicine commonly used for people with severe asthma has been successfully tested in several people with water allergies.
Some people with aquatic urticaria may not see improvement in symptoms with treatment and may need to minimize their exposure to water by limiting bathing time and avoiding water activities.
Prevention of water allergy in adults at home
Due to the rarity of the condition, preventive measures have not been developed.
Popular questions and answers
Answered questions about water allergies pharmacist, teacher of pharmacology, editor-in-chief of MedCorr Zorina Olga.
One hypothesis is that contact with water causes skin proteins to become self-allergens, which then bind to receptors on skin allergy cells. However, research is limited due to the extremely small number of patients with aquagenic urticaria and there is still little evidence to support either hypothesis.