Water Allergy: What You Should Know About Aquagenic Urticaria

Author: Numtas Thomas RN,RCCN, BNSc

Reviewed by Dr Azuka Chinweokwu Ezeike, MBBS, FWACS, FMCOG, MSc (PH)

Highlights

• Aquagenic urticaria is a real but rare condition where skin contact with water causes an allergic reaction
• The main trigger is contact with any form of water
• The water challenge test is the most specific test for diagnosis
• Treatment is focused on the management of symptoms
• Living with the condition requires water exposure reduction, emotional support, and proper management to maintain daily functioning.

Introduction

Mrs. Adams could not believe what she had just heard. It was both a relief and a shock when the doctor informed her that her teenage daughter had a ‘water allergy’. She has not been happy with her daughter for some time now, there seems to be an argument every time she asks her to do the dishes or the laundry. What pisses her off the most is that she has to remind her daughter to have a bath every day. She has not been particularly happy because her daughter, who is gradually becoming a young lady should know better than to be constantly reminded about cleaning or bathing.

 Although the daughter has tried severally to explain her discomfort every time water touches her, Mrs Adams is not buying it. She thinks her daughter is just lazy or careless. Mrs Adams and her daughter both left the doctor's office well-informed about this ‘rare’ condition and how best to manage it. 

What is aquagenic urticaria?

Aqua is the Latin word for water. Water is a universal substance that can be found almost everywhere. Although sources of water may differ, they all have the same chemical composition of hydrogen and oxygen. 

Water is needed for human survival - planting, drinking, cooking, washing, bathing and a whole lot of activities. A lot of manufacturers need and use water to produce their items. Water is life! Both man and animal depend on it. 

The American College of Allergy, Asthma and Immunology defines urticaria as a temporary, itchy skin rash or bump. The rash disappears almost as quickly as it appears. Urticaria can be caused by bites from insects, food like peanuts or shells, plants or even by treatment such as transfusion of blood. Your first point of contact when you use water is your skin. So, how your skin reacts to it is of importance. This article aims to help you understand what aquagenic urticaria is and what to do if you or a loved one experiences it. 

Is water allergy a real thing?

Yes. Water allergy, also known as aquagenic urticaria, exists, although cases are rare. Shelley and Rawnsley were the first people to explain this condition in 1964. [1] A typical reaction occurs within 30 minutes of contact of your skin with any form of water. This reaction can last for up to another 30 minutes or more, mostly affecting your upper body. Water allergy often comes with the appearance of a rash, itching and a stinging or burning feeling on the skin. It is generally an uncomfortable experience. 

Causes and triggers of water allergy

It is not clear what causes your skin to react to an everyday substance such as water. But doctors believe it occurs when certain cells in your body called mast cells release a chemical called histamine into the bloodstream as a result of water contact with your skin. The main trigger is skin contact with water, the temperature notwithstanding.  Water sources that can trigger a reaction include:

• Sea water
• Tap water
• Rain water

There are, however, other things that can increase the risk or trigger this allergy. These include: 

• Puberty
• Female gender
• Family history
• Swimming [2]

Symptoms of water allergy

Symptoms become obvious once you have contact with water, either from bathing, laundry or swimming. They include:

• Itchy skin
• Rashes
• Redness of the skin
• Stinging or burning feeling
• Swelling
• Appearance of hives [3]

When to see a doctor

The symptoms of aquagenic urticaria usually subside within a few hours. You should see your doctor when:

• Symptoms interfere with your daily activities
• Symptoms become worse
• You have difficulty breathing or swelling involving your lips and throat: this may signify an anaphylactic reaction and requires immediate treatment [3]

How aquagenic urticaria is diagnosed

Your doctor will take your history, perform some examinations and run some tests. 

• History: Your doctor will ask about the symptoms you experience after having contact with water. 
  • Your doctor will also ask about your source of water
  • How long the symptoms lasts
  • If you have any other health issues or allergies
• Physical examination: Your doctor will check if your symptoms are accompanied by any other health issues, like breathing problems. 
  • Your doctor will also check to see the extent of the spread of rash or hives, redness of skin or swelling. 
  • Your doctor will also require you to take a water exposure or challenge test. What happens in this test is that your doctor takes a piece of cloth, wets it with room temperature water, and the wet cloth is then placed on your skin. If you develop a rash or hives within twenty minutes of your skin contact with the wet cloth, then your doctor will diagnose you with aquagenic urticaria
• Blood tests: your blood will be tested for levels of immunoglobulin E, which is usually normal.
  • Blood levels of C-1 esterase inhibitors should be within normal levels. This test is important to rule out deep tissue swelling called angioedema
  • Blood levels of histamine may be high, but not in all cases [4]

 Other Similar Illnesses

Other diseases that may look like water allergy include: 

• Aquagenic pruritus: tingling or burning sensation with no hives after contact with water
• Cholinergic urticaria: itchy skin condition often associated with sweating, physical activity, or emotional stress.
• Cold urticaria: hives and skin redness caused by exposure to cold
• Solar urticaria: skin reaction to light exposure [5]

Treatment and management of aquagenic urticaria

The main trigger in aquagenic urticaria is water itself. Treatment and management are aimed at alleviating the symptoms since avoiding water completely may be impractical. 

Medications:

• Antihistamines: such as Cetirizine, to reduce hives and calm inflammation
• Barrier creams, especially those containing ceramides. Mostly used in combination with antihistamines
• Anti-allergy drugs called antileukotrienes are useful in reducing allergic symptoms. 
• Light therapy (phototherapy) is also used to reduce inflammation and promote skin healing
• Injection, such as omalizumab, also reduces allergic reactions [5]

Living with aquagenic urticaria

You may be wondering, since you cannot avoid water completely, does that mean your life is ruined? The answer is no. Your symptoms can be managed without affecting your daily activities. Here are helpful tips:

• Reduce your exposure to water. You can achieve this by taking a quick shower instead of a long bath and washing less frequently
• Use barrier creams before bathing
• Avoid vigorous physical activities that may induce sweat. Wear well-fitted and breathable clothes
• Manage heat by using fans or air conditioners
• Use raincoats to avoid contact with rain
• Use gloves while doing the dishes or handling water
• Drink water from a straw to avoid direct contact of your lips with water and possible spillage [3]

Emotional and social support

Living with aquagenic urticaria can take a toll on you emotionally. It can cause some people to fear or avoid showers completely. When you or a loved one has aquagenic urticaria, you can find support through: 

• Professional counselling by your doctor or therapist
• Support groups and communities of people with the same or similar health challenges
• Loved ones: talk to people close to you. Their help and support is important
• Educational materials: get more information on aquagenic urticaria and how best to manage it
• Contact a dermatologist for professional advice

Conclusion

Water allergy, also called aquagenic urticaria, is a rare but real condition. There is no permanent cure, but symptoms can be managed to avoid interference with daily activities. Find support for yourself or a loved one dealing with water allergy to make the journey less stressful. Always talk to your doctor if you experience symptoms suggesting aquagenic urticaria. 

References

1.  Chen Y-C, Hsu W-H, Sun C-M, Liu C-H. A case of aquagenic urticaria with a brief review of the literature. Dermatologica Sinica [Internet]. 2018 [cited 2025 May 24]; 36(3):146–8. Available from: https://www.sciencedirect.com/science/article/pii/S1027811717302069.

2.  Robles‐Tenorio A, Tarango‐Martinez VM, Sierra‐Silva G. Aquagenic urticaria: Water, friend, or foe? Clinical Case Reports [Internet]. 2020 [cited 2025 May 24]; 8(11):2121–4. Available from: https://onlinelibrary.wiley.com/doi/10.1002/ccr3.2880.

3.  Aquagenic Urticaria: Causes, Symptoms, and Treatment. Healthline [Internet]. 2017 [cited 2025 May 24]. Available from: https://www.healthline.com/health/aquagenic-urticaria.

4.  Rothbaum R, McGee JS. Aquagenic urticaria: diagnostic and management challenges. J Asthma Allergy [Internet]. 2016 [cited 2025 May 24]; 9:209–13. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5136360/.

5.  Abdi P, Diamond C, Stuckless JM. Aquagenic urticaria: presentation, diagnosis and management. BMJ Case Rep [Internet]. 2024 [cited 2025 May 24]; 17(11):e260364. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11557450/.

Disclaimer:
The information provided on this website is for general educational and informational purposes only. It is not intended to replace professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.

Published June 5, 2025