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Acquagenic Urticaria, Explained

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It’s super rare, but a water allergy is a thing.

BY MARA SANTILLIFEB 2, 2020

Woman with droplets of water in front of her shoulders
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You probably have a glass (or a fun, eco-friendly water bottle) sitting next to you or in your bag right now in order to meet your hydration goals for the day. And drinking enough water is super important—after all, about 60 percent of your body is made up of the wet stuff. But for some people, water isn’t the ultimate thirst-quenching fluid—it can actually be detrimental to their health.

While it’s pretty rare, a water allergy is a very real thing. The reaction happens when the body releases histamine when it’s exposed to water on the skin—and yes, that means from showering, swimming at the beach, and in some cases, even from just drinking a glass of H2O.

If you’re thinking, wait, how is that freakin’ possible? It’s a fair question because this phenom sounds totally crazy. But consider all your questions answered: Ahead, a dermatologist explains everything there is to know about water allergies—plus people who suffer from it explain what it’s like to live with it.

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But first: a little background on water allergies, which are medically referred to as aquagenic urticaria or aquagenic pruritus.

If you’re allergic to water, you would likely be diagnosed with one of those two conditions. Urticaria is the medical term for when a skin rash or hives appears, while pruritus means itchiness or an uncomfortable skin sensation. The former (aquagenic urticaria) is generally more severe, explains Sapna Palep, MD, a board-certified dermatologist at Spring Street Dermatology in New York City.

There have only been about 50 to 100 cases of aquagenic urticaria reported in medical literature, but there may be many more people living with it, especially in underdeveloped countries. Older research suggests that aquagenic urticaria is more common in women than men, and that most people get diagnosed during puberty. Aquagenic pruritus, on the other hand, may be slightly more common, according to 2017 research.

It’s not totally clear what causes a water allergy.

Most cases of aquagenic urticaria are sporadic and don’t have a clear underlying cause, Dr. Palep says, but there is a chance that it’s are genetic.

The physical triggers of a reaction include both still and running fresh water, sea water, bodily fluids like sweat and tears, and sometimes urine. In patients with aquagenic pruritus, there’s a histamine release from the mast cells (immune-boosting cells in your connective tissue that alert the body of foreign substances like bacteria or allergens) that then spurs the allergic reaction characterized by itching, hives, swelling, or burning, Dr. Palep explains.RELATED STORIESShould You Get Steroid Shots For Your Allergies?Q&A: Why Do I Suddenly Have Allergies?

Most of the time doctors don’t need to test patients for a water allergy; they can diagnose the condition by hearing about their symptoms. But if patients are unsure, their doctors can give what’s called a water provocation test to determine if they have a water allergy. The test involves applying room temperature water on a cloth to the patient’s skin and watching the patient carefully for a reaction.

Water allergies can have a range of symptoms, most of which are uncomfortable, to say the least.

For people with aquagenic pruritus, external symptoms include itching, pain, and burning; for people with aquagenic urticaria, water can cause a full-blown rash with hives and welts. The reaction can be immediate but usually happens within 20 to 30 minutes of skin coming in contact with water, Dr. Palep says.

In mild to moderate cases, the hives, rash, and itching tend to go away in 30 minutes to an hour, but that can be an incredibly painful, uncomfortable, and itchy hour. In rare cases, it can cause a life-threatening reaction. “Rarely do people go into anaphylaxis, but if you build up enough histamine to start wheezing, you could go into anaphylactic shock,” Dr. Palep notes. People with heightened reactions like this would need to carry an EpiPen.

Some people can’t even drink water if they have this allergy.

And, let’s be real, it’s tough to get around drinking water. Typically, with milder cases of aquagenic urticaria and aquagenic pruritis, drinking water is safe and may not cause external symptoms. But in severe cases, this can cause GI upset. Hansen-Smith can’t drink more than a few ounces of water without getting severe stomach cramps, so she drinks whole milk instead. “The sugars, fats and proteins help the water molecules sort of ‘sneak’ past my immune system so I can get some hydration,” she says.
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“I find it incredibly scary to have allergic reactions to my own sweat.”

For most people with any kind of water allergy, the bigger problem is if water is on skin for extended periods of time, like when they’re washing their face or in a bath or shower. These activities are safe but will likely be extremely uncomfortable during and afterward. There’s no cure or foolproof way to protect yourself from showering or bathing, sweating on a hot day, or even getting caught in a sudden rainstorm.

Niah Selway, an influencer who openly discusses her aquagenic pruritus on YouTube with her followers, has had the condition for the past five years and finds the simple process of getting clean to be the most frustrating. “Bathing and showering is the longest-lasting and most intense situation for me, because not only is it excruciatingly painful, but it’s also scary, fighting against your body to clean yourself and shave, without just giving in to the pain and giving up on the task at hand,” Selway says.

Treatment for a water allergy typically involves taking allergy medication and making lifestyle adjustments.

Most people who have a water allergy have to continuously take non-sedating antihistamines, such as Xyzal, to be prepared for a shower, a workout, or nasty weather. For people with chronic urticaria, a doctor might prescribe Omalizumab to help the body become less sensitive to the allergens, Dr. Palep explains.

In some mild or moderate cases of urticaria, a dermatologist would suggest phototherapy, says Dr. Palep. This treatment uses Narrowband UVB radiation, and studies have proven it can help suppress the immune system’s reaction in some patients’ skin cells to an allergen.

Unfortunately, there aren’t many other treatment options for people with a water allergy. “All you can do is be grateful for the things you learn during the process, and for the strength you inevitably find from enduring so much pain,” says Selway. “I strive to make others feel that they, too, can tackle whatever life may unexpectedly throw at them, even an allergy to water.”


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