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López-Rodríguez R, Castelo Galvan H, Perez-Quintero O, Rial Prado MJ, Gomez-Fariñas C, Parra Arrondo A, Hernandez JS, Veleiro Pérez B. Clinical and diagnostic features of 33 patients with aquagenic urticaria. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3272-3274. [PMID: 37364666 DOI: 10.1016/j.jaip.2023.06.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
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Rujitharanawong C, Kulthanan K, Tuchinda P, Chularojanamontri L, Metz M, Maurer M. A Systematic Review of Aquagenic Urticaria-Subgroups and Treatment Options. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2022; 10:2154-2162. [PMID: 35533998 DOI: 10.1016/j.jaip.2022.04.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND Aquagenic urticaria (AquaU) is a rare variant of chronic inducible urticaria where wheals occur after skin contact with water. Information on clinical manifestations and treatment outcomes is limited, which makes the management of AquaU challenging. OBJECTIVE To systematically review disease features and relevant triggers of AquaU and patients' response to treatment. METHODS Related articles were searched by use of the terms "aquagenic urticaria" and "aquagenic angioedema" until June 2021 and reviewed according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis recommendations. RESULTS A total of 77 patients with AquaU were investigated in 59 studies including 47 case reports and 12 case series. AquaU predominantly presented in women (47 patients, 61%), and the mean age of onset of the disease was 19.6 ± 10.8 years (range: 0-54 years). Wheals commonly occurred in localized areas and regardless of the water temperature. Based on the reviewed evidence, AquaU can be classified as familial AquaU (FAquaU, 18.2%) and acquired AquaU (AAquaU, 81.8%). Although many treatments were used in both subtypes of AquaU, the use of second-generation H1 antihistamines (2ndAH1) was reported most often to achieve marked improvement in both subtypes. The use of topical therapies in AquaU, which most commonly use hydrophobic vehicles, is poorly documented and of controversial efficiency. CONCLUSIONS AquaU is proposed to be classified into 2 subtypes, FAquaU and the more common AAquaU. Treatment with a 2ndAH1 is recommended as the first-line treatment for both types of AquaU. Further studies are required to fill knowledge gaps.
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Affiliation(s)
- Chuda Rujitharanawong
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Kanokvalai Kulthanan
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Papapit Tuchinda
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Leena Chularojanamontri
- Department of Dermatology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Martin Metz
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany
| | - Marcus Maurer
- Institute of Allergology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany; Fraunhofer Institute for Translational Medicine and Pharmacology (ITMP), Allergology and Immunology, Berlin, Germany.
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Kaur S, Jabbal IS, Bhasin AK. Omalizumab as a treatment option for antihistamine-refractory aquagenic urticaria. BMJ Case Rep 2022; 15:e251057. [PMID: 35850790 PMCID: PMC9297225 DOI: 10.1136/bcr-2022-251057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/05/2022] [Indexed: 11/03/2022] Open
Abstract
A teenage girl presented with symptoms of itching and hives on contact with water for 3 years. On specific provocative testing and ruling out underlying systemic conditions, she was diagnosed with aquagenic urticaria. Following failed attempts to control her symptoms with second-generation antihistamines, she was started on monthly subcutaneous injections of the monoclonal antibody, omalizumab. The patient demonstrated significant improvement, with symptoms being well-controlled for 2 years now. She enjoys a good quality of life and can take a shower without developing itching or hives.
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Affiliation(s)
- Sehajpreet Kaur
- Internal Medicine, AdventHealth, Sebring, Florida, USA
- Allergy, Mayo Clinic, Jacksonville, Florida, USA
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Robles‐Tenorio A, Tarango‐Martinez VM, Sierra‐Silva G. Aquagenic urticaria: Water, friend, or foe? Clin Case Rep 2020; 8:2121-2124. [PMID: 33235740 PMCID: PMC7669369 DOI: 10.1002/ccr3.2880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 02/24/2020] [Accepted: 03/20/2020] [Indexed: 11/07/2022] Open
Abstract
There are <100 reported cases of aquagenic urticaria. Although most are sporadic, several diseases have been associated. Diagnosis is based on provocation tests. Second-generation antihistamines are the first-line treatment.
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Affiliation(s)
- Arturo Robles‐Tenorio
- CUCS Universidad de GuadalajaraGuadalajaraMéxico
- Instituto Dermatologico de Jalisco “Dr. José Barba Rubio” (IDJ)ZapopanMéxico
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Pozderac I, Lugović-Mihić L, Artuković M, Stipić-Marković A, Kuna M, Ferček I. Chronic inducible urticaria: classification and prominent features of physical and non-physical types. ACTA DERMATOVENEROLOGICA ALPINA PANNONICA ET ADRIATICA 2020. [DOI: 10.15570/actaapa.2020.29] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Hamie L, Abou-Rahal J. Water-related dermatoses. Int J Dermatol 2018; 58:515-529. [PMID: 30506676 DOI: 10.1111/ijd.14316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 09/27/2018] [Accepted: 10/31/2018] [Indexed: 01/22/2023]
Abstract
Water-related dermatoses are a spectrum of diseases that are associated with water exposure. They result either from the direct influence of water or after injury from water inhabitants. In this review, clinical entities that manifest after water exposure (aquagenic pruritus, aquagenic urticaria, and aquagenic wrinkling of the palms) will be discussed with particular focus on the reported pathogenesis. Aquatic organisms and activities can be linked to cutaneous injuries that require identification and distinct management. Marine and freshwater dermatoses were summarized to provide physicians with easy access to the causative organism, method of injury, and appropriate management.
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Affiliation(s)
- Lamiaa Hamie
- Department of Anatomy, Cell Biology and Physiological Sciences, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Jihane Abou-Rahal
- Department of Dermatology, American University of Beirut Medical Center, Beirut, Lebanon
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Napolitano M, Gallo R, Donnarumma M, Patruno C. Salt-dependent aquagenic urticaria in children: Report of two cases. Pediatr Allergy Immunol 2018; 29:324-326. [PMID: 29337390 DOI: 10.1111/pai.12862] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | - Rosella Gallo
- Section of Dermatology, Department of Health Sciences (Di.S.Sal), University of Genoa, Genoa, Italy
| | - Marianna Donnarumma
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Wang F, Zhao YK, Luo ZY, Gao Q, Wu W, Sarkar R, Luo DQ. Aquagene Hauterkrankungen. J Dtsch Dermatol Ges 2017; 15:602-609. [PMID: 28591437 DOI: 10.1111/ddg.13234_g] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/01/2017] [Indexed: 11/24/2022]
Affiliation(s)
- Fang Wang
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yu-Kun Zhao
- Department of Dermatology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ze-Yu Luo
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Qian Gao
- Department of Dermatology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Wu
- Department of Dermatology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Rashmi Sarkar
- Department of Dermatology, Maulana Azad Medical college and LNJP Hospital, New Delhi, India
| | - Di-Qing Luo
- Department of Dermatology, The Eastern Hospital of The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Wang F, Zhao YK, Luo ZY, Gao Q, Wu W, Sarkar R, Luo DQ. Aquagenic cutaneous disorders. J Dtsch Dermatol Ges 2017; 15:602-608. [PMID: 28513988 DOI: 10.1111/ddg.13234] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 03/01/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Fang Wang
- Department of Dermatology; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Yu-Kun Zhao
- Department of Dermatology; The Eastern Hospital of The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Ze-Yu Luo
- Department of Dermatology; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Qian Gao
- Department of Dermatology; The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
| | - Wei Wu
- Department of Dermatology; Affiliated Hospital of Guangdong Medical University; Zhanjiang China
| | - Rashmi Sarkar
- Department of Dermatology; Maulana Azad Medical college and LNJP Hospital; New Delhi India
| | - Di-Qing Luo
- Department of Dermatology; The Eastern Hospital of The First Affiliated Hospital; Sun Yat-sen University; Guangzhou China
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Seol JE, Kim DH, Park SH, Kang JN, Sung HS, Kim H. Aquagenic Urticaria Diagnosed by the Water Provocation Test and the Results of Histopathologic Examination. Ann Dermatol 2017; 29:341-345. [PMID: 28566914 PMCID: PMC5438944 DOI: 10.5021/ad.2017.29.3.341] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/24/2016] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
An 18-year-old male visited our department complaining of recurrent episodes of an itchy rash after hand washing, showering/bathing, drinking water, and getting rain-soaked. He was diagnosed with aquagenic urticaria after a water provocation test and histopathologic examination. Five months of antihistamine treatment successfully prevented further wheal formation. Aquagenic urticaria is a very unusual form of physical urticaria caused by contact with water. It manifests as pruritic small wheals surrounded by erythema within 30 minutes of exposure. The condition can be diagnosed by a water provocation test. Systemic antihistamines are the first-line treatment, with anticholinergics, phototherapy, or barrier cream used alternatively or additionally. Four cases of aquagenic urticaria have been reported in Korea, but no histopathologic evaluation was reported in the English or Korean literature. Herein, we provide both a case report of aquagenic urticaria diagnosed by the water provocation test and histopathologic examination results for this patient.
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Affiliation(s)
- Jung Eun Seol
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Do Hyeong Kim
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - So Hee Park
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Jeong Nan Kang
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Ho Suk Sung
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hyojin Kim
- Department of Dermatology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Rothbaum R, McGee JS. Aquagenic urticaria: diagnostic and management challenges. J Asthma Allergy 2016; 9:209-213. [PMID: 27942227 PMCID: PMC5136360 DOI: 10.2147/jaa.s91505] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aquagenic urticaria (AU) is a rare inducible form of physical urticaria, which occurs in response to cutaneous exposure to water, including sweat and tears. Patients present with characteristic 1–3 mm folliculocentric wheals with surrounding 1–3 cm erythematous flares within 20–30 minutes following skin contact with water. In rare cases, there are concomitant systemic symptoms, such as wheezing or shortness of breath. The pathogenesis of AU is poorly understood at this time, and it appears to be mediated in both a histamine-dependent and independent manner. Diagnosis is based on eliciting a thorough clinical history combined with a water challenge test. Some patients may need to undergo further testing to exclude other physical urticarias. Rarely, multiple physical urticarias can be present in one patient, which can complicate diagnosis and treatment. Currently, the first-line therapy for AU is an oral administration of nonsedating, second-generation H1 antihistamines, but many patients may require further interventions to have adequate symptomatic control. In this review, we discuss the diagnostic and management challenges of AU. We review the key diagnostic features that differentiate AU from other physical urticarias. We additionally describe a therapeutic ladder for the treatment of AU and the rationale supporting these treatments.
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Affiliation(s)
- Robert Rothbaum
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
| | - Jean S McGee
- Department of Dermatology, Boston University School of Medicine, Boston, MA, USA
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A case of aquagenic urticaria successfully treated with omalizumab. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:547-8. [DOI: 10.1016/j.jaip.2015.12.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/07/2015] [Accepted: 12/22/2015] [Indexed: 11/23/2022]
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Urticaire aquagénique localisée à l’eau de mer. Ann Dermatol Venereol 2015; 142:771-5. [DOI: 10.1016/j.annder.2015.10.582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2015] [Revised: 06/15/2015] [Accepted: 10/02/2015] [Indexed: 11/24/2022]
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