Water Hives

By | June 10, 2022

Water hives are a dermatological reaction to contact with water. Those affected show swollen and itchy wheals on the skin after contact with water. The administration of antihistamines to alleviate the symptoms is an option.

What is water hives?

Hives are a dermatological reaction. It is a skin reaction that the body produces when it comes into contact with allergens. The skin reaction corresponds to punctate, button-like or reddened wheals and erythema caused by allergic processes in the dermal blood vessels. For myocardial hypertrophy overview, please visit homethodology.com.

Hives are not only associated with medication, food, psychological stress or immunological phenomena. The symptoms described can also occur as a reaction to contact with heat, light, pressure or water. Depending on the cause, medicine distinguishes different types of hives. Water hives is one of them.

In this aquagenic form of urticaria, the skin reacts to exposure to water with a rash. The rash often appears seconds after contact and lasts about two hours on average. In addition to congenital forms of water hives, acquired forms of the disease have been observed. Some patients report a slow improvement in symptoms over the course of their lives.

Water hives are a rather rare form of hives and were first described towards the middle of the 20th century. Shelley and Rawnsley are the first to describe it. According to a British tabloid, only 35 cases have been documented worldwide after the first description.


Water hives are sometimes classified as allergies. But that is not entirely true. Allergies are characterized by the release of the neurotransmitter histamine, which triggers the characteristic immune response. Water hives are often, but not always, associated with the release of histamine.

Therefore, it is probably not an actual water allergy, but rather a dermatological reaction to substances such as chlorine or certain ions found in non-distilled water. Some of the cases documented to date suggest a genetic disposition for water hives. Familial clustering has sometimes been observed. The investigation of the reactions in pairs of twins speaks in favor of a genetic disposition.

In addition to the genetic form of water hives, there also appears to be a non-hereditary form, as is assumed, for example, for the acquired types of water hives. Since the majority of the patients documented to date have been isolated cases with no family history, the sporadic occurrence of the symptoms seems to be the more common variant. The causal relationships have not been conclusively clarified for this variant.

Symptoms, Ailments & Signs

Water hives patients react to contact with water with symptoms similar to those caused by contact with stinging nettles. Around 15 minutes after contact, small whitish papules appear at the points of contact with the water, which often persist for two hours. Associated symptoms are usually more or less severe itching.

Slight reddening of the surrounding skin areas was also observed in the patients. Not every type of water has to trigger these reactions. Often only rainwater leads to the skin changes. Other patients only react to contact with sea water. However, some sufferers also report regular rashes after showering. Only in exceptional cases does the type of water play no role in the reaction.

The clinical picture of the skin reactions can differ significantly from case to case. In addition to the color changes and the itching, some patients also have swelling, for example, which is usually due to the increased release of the messenger substance histamine. Whether and how much histamine the patient releases in contact with water differs from case to case.

Diagnosis & course of disease

The diagnosis of water hives is initially made by the doctor based on the anamnesis. In order to confirm such a suspected diagnosis on the basis of the anamnesis, body-warm compresses that have been soaked with water are placed on the patient. If the skin reactions described then appear, the diagnosis is considered to be secure. The prognosis for the patient is usually favorable. In many cases, an absolute remission of the disease occurs in the course of life.


In most cases, water hives do not lead to serious complications or serious symptoms. The symptoms can be treated relatively easily, so that there is no permanent damage. First and foremost, water nettle rash leads to severe reddening of the skin in those affected and also to itching. This can be further aggravated if the patient scratches the skin.

Swelling of the skin can also occur. Many patients feel uncomfortable with the symptoms and thus suffer from significantly reduced self-esteem and inferiority complexes. Children can be bullied or teased, leading to psychological problems.

If the water hives occur after a simple contact with ordinary water, this can lead to considerable restrictions in the patient’s everyday life. As a rule, the symptoms of water hives are treated with the help of medication. However, a complete and causal cure is not possible. There are no complications with the treatment. Likewise, this disease does not reduce the life expectancy of the patient.

When should you go to the doctor?

If you have water hives, you need to see a doctor. As a rule, this disease cannot heal itself, so that early diagnosis and treatment always has a positive effect on the further course of the disease. A doctor should be contacted as soon as the first symptoms and signs appear in order to prevent further problems. A doctor should be consulted for water hives if the affected person shows very strong reddening of the skin after contact with water. There is also severe itching, with the symptoms lasting for several hours.

Swelling after contact can also indicate water hives and should be examined by a doctor. The color of the skin often changes and indicates this disease. The initial diagnosis can be made by a general practitioner or an allergist. Treatment is not always necessary, so that the further course depends very much on the severity of the symptoms. As a rule, water hives do not reduce the life expectancy of the person affected.

Treatment & Therapy

If the patient’s water hives can be linked to the release of histamine, the administration of antihistamines is considered the most important therapeutic step. Antihistamines are histamine receptor blockers known as histamine receptor antagonists. The active ingredients in these drugs weaken or even completely neutralize the effect of histamine by blocking the body’s own histamine binding sites.

Antihistamines are available for four different histamine receptors. The drugs are therefore divided into H1, H2, H3 and H4 antihistamines. The H1 and H2 antihistamines show the most therapeutic effect and are therefore considered to be the most relevant drugs in the treatment of allergies.

If the skin reactions of patients with water urticaria cannot be traced back to the effects of the messenger substance histamine, symptomatic treatment with antihistamines is unsuccessful. Sometimes causal therapy for water urticaria is considered in these patients. In this therapy, sufferers are regularly exposed to distilled water until repeated exposure causes symptoms to resolve.

However, this therapeutic option is not always crowned with success. The supportive therapy steps include, above all, extensive counseling of the patient. Those affected should gear their everyday life to the illness and, for example, keep showers as short as possible.


So far, there are no preventive measures available for water hives because the connections have not been conclusively clarified.


In most cases, the measures of direct aftercare for water hives are significantly limited, so that the person affected should seek professional medical care so that complications or other symptoms do not arise in the further course. As a rule, this disease cannot heal itself, so that the person affected should contact a doctor as soon as the first symptoms or signs of water hives appear.

Most of those affected are dependent on taking medication that can alleviate and limit the symptoms. The doctor’s instructions should always be followed, and if you have any questions or are unclear, you should always contact the doctor first. Furthermore, the trigger of water hives should be avoided if possible. Contact with water, such as when showering, should be kept as short as possible to prevent the symptoms from reoccurring.

Likewise, the underlying allergy should be treated to relieve water hives. Most of those affected also depend on the help and care of their own families during treatment. The attention can reduce the development of depression and other mental disorders. As a rule, this disease does not limit or reduce the life expectancy of the affected person.

You can do that yourself

Although this condition is extremely rare, it can be distressing for those affected. This does not only affect the symptoms, the itching or hives after contact with water, because this allergic reaction can be treated with antihistamines.

But since the condition is mostly hereditary, it affects patients from an early age. Unlike their schoolmates, they cannot play with water or go for a carefree swim in the summer. This can lead to teasing and bullying. In these cases, psychological support is advisable. If the affected person reacts to all types of water, this can significantly reduce their quality of life. Here the patient has to learn to deal with his situation: to use gloves when coming into contact with water, to wash himself briefly instead of taking a shower, etc.

The symptoms of redness, swelling and itching are best relieved with cooling. Cooling gel pads, which are called Coolpads in the trade, are suitable for this. They are available in pharmacies without a prescription. Coolpads are best kept in the freezer compartment of the refrigerator and removed when needed. However, they should not be placed directly on the reddened, itchy areas, as they also draw water and can aggravate the symptoms. On the other hand, putting on cold Coopads can lead to cold burns. Therefore, the pillows should be wrapped with a towel before laying them out.

Water Hives