WHAT-ER ALLERGY

Fewer than 100 cases have been documented worldwide as of recent reviews, with some estimates citing around 77–100 total cases in the medical literature.

A retrospective study of 296 children with chronic urticaria at a Northern India tertiary centre (2021) found just 4 cases of aquagenic urticaria—that’s 1.35% of all chronic urticaria cases in that group.

H2O-No!

Most of us come home sweaty and tired, and the moment we reach home, the first thing we do is go for a shower because it's only natural to do so. But for someone with this condition, each of these everyday experiences can result in a very painful state; water itself is the problem, not the chlorine, minerals, or impurities in it.

Dr Vaibhav Kalambe, Consultant Dermatologist at AIMS Hospital, Dombivli says that aquagenic urticaria is a rare condition where contact with water triggers hives. “Its exact cause is unclear, but it may involve a hypersensitive skin reaction or immune response to water interacting with skin compounds,” Dr Vaibhav says.

It doesn’t matter where the water comes from, rain, tap, or bottled water — it all has the same effect. Even sweat or tears can trigger a painful skin reaction. In fact, crying can hurt as well. Which means heartbreak is now both emotional and physical.

Believe the Unbelievable

So, how does one confirm if someone is allergic to water? “We do something called a water challenge test,” explains Dr. Kalambe. “We apply water at room temperature to a small area of skin and observe for about 10 minutes. If hives or welts appear, it confirms the diagnosis.”

There’s no fancy lab test or blood work.

It’s all about observation. But because this condition is so rare —only a few cases are reported globally each year — it’s often misunderstood or missed altogether.

Many patients go through months, even years, of confusion. They’re told they have eczema, allergies, anxiety, or “sensitive skin.” But the truth is far stranger than fiction. “In India’s climate, managing sweat becomes a major challenge. Many patients have to adjust their whole lifestyle — what they wear, how they bathe, even what time they go outside. It takes a physical and emotional toll,” says Dr Neeraj Ghosh, allergy specialist.

Shower with Caution

Currently, there is no cure for aquagenic urticaria, but treatment and lifestyle adjustments can help patients live more comfortably. “Antihistamines are the first line of defence,” says Dr. Kalambe. “They help manage the allergic response. We also recommend barrier creams, which can protect the skin by forming a thin layer between it and the water.”

Phototherapy is another line of treatment which can help reduce the skin’s sensitivity. “Patients should stay cool and dry,” Dr. Kalambe advises. “Lukewarm, quick showers and using barrier creams beforehand can reduce reactions.”

Exercising, swimming, dancing in the rain — things most people enjoy —can become full-on nightmares. “Aquagenic urticaria is so rare that many dermatologists might go their entire careers without seeing a case. But rare doesn’t mean impossible. The key is not to dismiss patient complaints just because they don’t fit a typical pattern. If someone repeatedly reports skin flare-ups after water exposure — especially with no identifiable allergen — we need to investigate,” says Dr Anjali Menon, consultant dermatologist.

Final Splash

Aquagenic urticaria doesn’t just impact the skin; it leaves the individual scarred mentally as well. Some patients resort to showering once every few days, cleaning with wet wipes, or skipping events where water exposure might happen. “We haven’t had a patient at our hospital with aquagenic urticaria yet,” says Dr. Kalambe, “but I think more awareness is needed. People with unexplained rashes after contact with water should speak to a dermatologist.”