A review on aquagenic urticaria: unraveling the mystery of water-induced hives

Aquagenic urticaria, a type of physical urticaria, wheals occur when a patient's skin makes contact with any type of water within 30 min of exposure, and can last for 30 min to 2 h after cessation of exposure. Aquagenic urticaria most commonly develops on the trunk and upper limbs. It is sometimes associated with pruritus and an uncomfortable prickling or burning sensation. Patients with AU will present with characteristic 1–3 mm folliculocentric wheals and surrounding 1–3 cm erythematous flares within 20–30 minutes following skin contact with water. Aquagenic urticaria is not being adequately treated at the moment. This condition is frequently treated with long-acting antihistamines. Research is still being conducted to determine the underlying genetic and environmental factors that contribute to AU, which is uncommon but can have a significant impact on quality of life.  A better understanding of the role of histamines, the immune system, and specific triggers might enable the development of targeted therapies.