Water allergy - symptoms, causes and treatment

Water allergy - symptoms, causes and treatment

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Allergic reactions due to water

Allergic to water? That sounds like a joke from dirty finches who don't want to wash themselves, but it's a bitter reality, if only for a few dozen people worldwide. The phenomenon is also known as water hives, aquatic urticaria or aquagenic urticaria. Those affected have allergic reactions when they come into contact with water, which can lead to death from shock.

Water allergy - the most important facts

  • It is a form of hives in which those affected develop symptoms when they come into contact with water.
  • Drinking water is easy, the body does not react inside. The symptoms arise when water touches the skin.
  • When the skin comes into contact with water, pustules develop and the skin turns red.
  • Those affected suffer from itching and pain.
  • There is a risk of allergic shock.
  • Water hives is one of the rarest diseases, only three dozen cases are known worldwide.
  • The causes have not been sufficiently clarified. Some patients overproduce histamine when in contact with water. From a medical point of view, it is an allergy. In other similar reactions, histamine is not the cause of the symptoms.

Inducible urticaria

This word monster describes forms of hives with clear triggers such as

  • physical exertion,
  • Warmth,
  • Light,
  • Cold,
  • Pressure on the skin (physical hives),
  • allergic reactions to substances in food and medication
  • and stress with so-called stress-induced hives (here the trigger is psychological stress).

Water allergy is one of the physical forms. Two thirds of all cases of hives are inducible.


About 15 minutes after contact with water, be it through a bath in the lake, contact with rain or sea water, whitish itchy papules form on the skin. Reddened wheals can also take the form of buttons or dots. The skin can also swell - this is usually a sign of an increased release of histamine. Not all patients react to all forms of water, some only to sea water, others feel the skin hurts like a burn, regardless of whether they wash their hands or melt snow on their skin.

Water hives

Shelley and Rawnsley were the first to describe hives in 1964, which occurs when people come into contact with water. The phenomenon is extremely rare, around 35 diseases are currently known worldwide.

Is it really an allergy to water?

You should be very careful when diagnosing. There are a lot of other substances in water that can trigger allergies. If you are allergic to this, it is not a reaction to the water. For example, allergenic substances can collect on your skin, which dissolve during washing and penetrate the skin.

There may be metals in the tap water that adhere to the water pipes, but also lime and salts. These even trigger allergies quite frequently, as does chlorine, which is present in tap water in small quantities (in other countries in larger quantities). Almost everyone knows that their skin is irritated after visiting a swimming pool. This is also why you should take a shower in a public facility after swimming. In addition, there are biological substances, germs, bacteria, fungi and other microbes that are found on taps or in water pipes. For example, if you become infected with allergy tests or cholera, you don't suffer from water hives. If you have an allergic reaction, this can be found out by means of an allergy test, which you can have carried out in an allergological practice.

Affected people only react to water that comes to their skin from the outside. They have no problems inside the body. For example, they can drink with a straw and only develop symptoms if the water drips onto their chin, for example. But once it is in the mouth, there are no further complaints.


There is no clarity about the causes of water hives. A twin test revealed a genetic predisposition, but there may also be acquired forms of the disease, and in some patients symptoms have decreased over time. For some, the disease broke out in early childhood, for others in pre-puberty, and for others, almost in young adulthood.

In contrast to "real" allergies, it is often not an excess of the neurotransmitter histamine, but a reaction of the skin. For example, chlorine allergy is not an allergy in the narrower medical sense.


With allergy tests, the doctor recognizes whether it is water hives. To do this, he puts compresses soaked in water on the patient's skin. The diagnosis is considered certain if the skin turns red, itchy and / or pustules without other possible stimuli.


The disease can be treated well, but not cured. If the cause is the increased release of histamine, then antihistamines help effectively. If the cause is unclear, then medications relieve skin reactions. In this case, a life plan is very important in order to avoid the trigger in everyday life.


You cannot prevent water hives because the cause of the disease is not clear.

What are antihistamines?

These histamine receptor antagonists block the places in the body where histamine binds. These drugs are available for four different histamine receptors: H1, H2, H3 and H4. H1 and H2 blockers are the most effective and are therefore most often used against allergies.

Everyday stress

Patients are often mentally stressed. Children fear being bullied and sometimes will. If the disease does not only occur with certain forms of water so that contact can be avoided (as with sea water), then this hives extremely restricts those affected in everyday life:

  • You cannot wash your hands.
  • You cannot go outside even in light rain.
  • They cannot walk through wet grass as they fear they may get wet feet.
  • When drinking, you must be careful not to get a drop on your skin.
  • For their daily hygiene, they have to resort to means such as dry shampoos or wipes - cleaning the body without water is not impossible, but it is expensive.

When do you need to see a doctor?

Water hives almost never go away on their own. Therefore, you should see a doctor at the first symptoms, i.e. if the skin turns red on contact with water. You can go to your family doctor and he will refer you to an allergist for safety.

How dangerous is the disease?

Water hives are very, very rare. The probability that it will hit you is one in 100 million. The severity of the disease differs among all those affected today - here are a few examples:


One patient, Emily, reacted so strongly that she was no longer able to play sports, since even sweating causes her skin to rash intensely. She cleans herself with damp towels and no longer takes a shower. She is at risk of an allergic shock at any time, which can bring the heart to a standstill and thus lead to death.

Alexandra Allen

Alexandra Allen's entire body was itchy at the age of twelve when she climbed into the swimming pool. The doctors suspected a chlorine allergy - in contrast to water hives, a common reaction. Alexandra was skeptical and did her own research on the Internet. Then she found all of her water allergy symptoms. Despite treatment, she can often only lie in bed with pain when she comes into contact with water.

Ivy Angermann

The Minnesota child Ivy Angermann screamed when the parents bathed it and the skin was flushed. The parents suspected that the daughter was allergic to the bath foam, but allergy tests showed that the girl had water hives. In this case, it is strictly an allergy, so Ivy was treated with antihistamines. (Dr. Utz Anhalt)

Author and source information

This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.


  • B Wüthrich / G Hofbauer / T Kündig: Physical urticaria: clinic, diagnostics and therapy, Swiss Med Forum. 2006, medicalforum.ch
  • Shelley, Walter B. / Rawnsley, Howard M .: Aquagenic Urticaria Contact Sensitivity Reaction to Water, Jama Network, 1964, jamanetwork.com
  • German Dermatological Society (DDG), German Society for Allergology and Clinical Immunology (DGAKI): S3 guideline urticaria, classification, diagnostics and therapy, as of April 2011, awmf.org
  • Prof. Dr. med. Peter Altmeyer: Urtikaria aquagene (accessed: 03.07.2019), enzyklopaedie-dermatologie.de
  • Genetic and Rare Diseases Information Center (GARD): Aquagenic urticaria (accessed: 03.07.2019), rarediseases.info.nih.gov

ICD codes for this disease: L50ICD codes are internationally valid encodings for medical diagnoses. You can find yourself e.g. in doctor's letters or on disability certificates.

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