A Rare Case When a Water Issue Turns Out to Be an Issue With Water

When skin irritation arises after contact with water, the first suspicion often falls on the water's quality. What if the problem isn't in the water, however, but in a rare reaction of the skin to water itself? We explore a unique case where concerns about water quality led to the unexpected discovery of Aquagenic Urticaria, a rare condition also known as Water Allergy or Water Urticaria (hives). When we say rare, we mean rare. There are only about 100 cases reported in the published literature (Source: WebMD).

The Mystery of Aquagenic Urticaria

It starts with unexplained skin reactions that appear as small raised bumps on the skin that may itch, surrounded by a significantly larger reddish area. The redness lasts about 30 to 60 minutes and occurs on the portion of the body that has been exposed to water. This water contact can include bathing, swimming, sweating, or even tears. In addition to the “bumps and redness,” the person may experience fainting, shortness of breath, headache, dizziness, and other respiratory issues. This condition is more common in females (women) then men, but in either case the first episode is typically associated with puberty.  Our new drinking water educational booklet - "Our Drinking Water".

The immediate suspicion? Something must be wrong with the water and, to be honest, you may be correct. This thought process leads many to investigate their water supply, searching for contaminants or harmful chemicals in the home and community, bacterial agents, the condition and state of the water, and even the water temperature. When we need to solve a mystery the first step is to compile the clues, the what, where, how, and whom and it is important to ask yourself the following:

1. Is it a problem for all members of the house?

2. Is this occurring with both hot and cold water?

3. Are there any aesthetic issues with the water, such as: an odor, films, coatings, or problems with the feel of the water, such as it is slimy, gritty, or is there a soap residue?

4. Is it something else? Try using a symptom checker on the Internet.

5. Ask a professional

Investigating Water Quality

As with any such concern, the logical first step may be to just blame the water and put in a water treatment system, but this is jumping to conclusions and we must approach these unknowns like a scientist. We call this process the POT Process. First, we Prepare (P): This means we might list all the potential causes, compile all the background information and begin to prepare a list of the potential causes. Then, we Observe (O) or compile additional new information to evaluate the potential causes, and then finally we Translate (T) the data into a formal hypothesis of what may be wrong. We do not jump to conclusions.

For your potable water source, this means understanding the source of the water, how the water may or may not be treated and then getting the water tested. Homeowners and individuals often turn to local water testing services, expecting to find a culprit like high chlorine levels or a lurking microorganism. Yet, in cases of Aquagenic Urticaria, these tests return with a twist – the water is perfectly fine, meeting all safety and health standards, which does not help the fact that many water system customers do not trust their water supplier. This is why it is important to trust your expert and Get Your Water Tested.

In other cases, the testing may identify a problem such as: high bacterial count, fungi, cyanobacteria (Blue-green algae), very low to very high pH, very high levels of chlorine, very hard water, presence of a volatile or semi-volatile compound, and even chromium which can cause dermatitis. Therefore, the water quality may be a problem and it is possible that trace elements, bacterial quality, or the condition of the water may cause the water to damage the skin barrier. The redness of the skin could also be related to an infection, allergic reaction, or symptom of another illness, such as a virus or autoimmune disorder.

Unveiling the Real Culprit

After water quality and water temperature issues have been ruled out, the journey towards understanding these skin reactions gets more complicated. This path often leads to a healthcare professional, typically a dermatologist, who can unravel the mystery and it may be wise to conduct some screening testing to determine if you are sensitive to any specific food or environmental factors.

After thorough examinations and considering the unique symptoms, a diagnosis of Aquagenic Urticaria might emerge following a “water challenge test,” bringing both answers and new challenges. During this challenging testing, the physician would put a wet compress on the person's skin and after 20 minutes check to see if a rash appears.

Decoding Aquagenic Urticaria

Aquagenic Urticaria is an exceedingly rare condition where the skin reacts negatively to contact with water. This reaction is not a traditional allergy, as it doesn't involve the immune system reacting to a specific allergen. Instead, it's a form of hypersensitivity where even the purest water can trigger symptoms.

Adapting to a Water-Sensitive Life

The discovery of having a water allergy necessitates significant lifestyle adjustments. From taking shorter, cooler showers to avoiding swimming and careful management during rainy days, every aspect of water interaction requires consideration. Living with this condition means constantly balancing the necessity and presence of water in daily life with the physical reactions it provokes.

Treatment for the Condition

The primary recommended treatment in the literature for Aquagenic Urticaria is to take a second-generation H1 antihistamine that is non-sedating, such as: Cetirizine. The other treatment options that have been reported are to apply an ointment or cream to create a barrier, utilize UV light therapy (Phototherapy), or use an allergy medicine like Omalizumab (Xolair).

Water and Health

Water quality and health are often interdependent. Diagnosing issues with your water is often part of diagnosing health-related issues. This process can range from simple to complex. Ironically, in the rare case of a water allergy, discovering there wasn't an issue with the chemistry or biological properties of the water revealed an adverse health issue that may be related to genetics.

If you suspect your water is causing a health issue, follow the Path to Clean Water. Get Informed, Get Tested, and Get Treatment. And when in doubt, reach out to experienced water professionals who can be helpful guides and read up on Aquagenic Urticaria.

If you have questions or concerns about your water, Contact the KnowYourH2O team.

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Initial draft prepared with assistance from ChatGPT(2023), further developed and finalized by Brian Oram, Licensed Professional Geologists. Editing by Dr. Brian Redmond.