Patient: A teenage girl living in Canada.
Symptoms: This teenage girl comes to the clinic because her hives recur every time her skin comes into contact with water. When she visited the clinic, she was suffering from hives. The inflamed bump was surrounded by red patches of skin about 0.4 to 1.2 inches (1 to 3 centimeters) wide.
What happened next: The patient told her doctor that the first time she developed hives in response to water was about two years ago, shortly after she started her menstrual periods. After that, welt swelling appeared every time her skin got wet, regardless of the temperature or type of water.
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She developed hives within 20 minutes after bathing or showering. Swim in the pool or sea. Or after getting wet in the rain. The hives and redness will disappear after about 30 to 60 minutes without any treatment. She told doctors that sweat and tears on her skin were not causing her symptoms.
Hives, also known as hives, are usually caused by an allergic reaction to something the affected person has touched or eaten. When allergens enter the body, immune cells release a chemical called histamine, which causes an immune response such as itchy hives.
Doctors wrote in the case report that the patient’s family had no history of unexplained hives and did not report other symptoms that can accompany an allergic reaction, such as dizziness, wheezing or shortness of breath. Laboratory tests of the patient’s blood and urine showed that all her vital functions were within normal limits.
She was allergic to dust, rabbits, and cats, but these known allergens did not overlap with her hives attacks after exposure to water.
Diagnosis: The doctor prescribed the patient an antihistamine for 1 week. Thereafter, the medication was discontinued, and a challenge test was conducted in which the subjects’ skin was intentionally exposed to the suspected allergen by applying a cloth soaked in room temperature water to their abdomens. Within 20 minutes, the welts became noticeable.
Based on the results and the patient’s medical history, doctors diagnosed her with aqueous urticaria, a rare water allergy.
Treatment: The girl’s mother had previously tried to manage her daughter’s hives with montelukast, which treats and prevents asthma symptoms such as swelling and inflammation of the airways. The drug improved the boy’s symptoms to some extent, but it did not completely resolve them.
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Instead, doctors prescribed her a daily dose of cetirizine, an antihistamine that targets the causes of various allergy symptoms, including hives, sneezing, and itchy eyes, nose, and throat. During a follow-up visit 8 months later, the patient reported that her symptoms returned only when she forgot to take her antihistamine.
Her condition continued to improve over time. When she returned for a 14-month follow-up, she said she was able to participate in normal daily activities “without any restrictions” and that her quality of life was not affected by the allergy as long as she continued to take cetirizine, the report said.
What’s unique about this case: Researchers have only previously reported 100 cases of aqueous urticaria. Although its cause is unknown, the condition generally appears at the beginning of adolescence and is thought to affect women more often than men.
This allergic reaction is difficult to diagnose because it is difficult to identify water as the cause of hives, as hives can be caused by pressure, extreme temperatures, exercise, and even various allergens.
In this case, the patient’s detailed medical history and the results of provocation tests allowed the doctor to pinpoint the cause of the patient’s abnormal condition.
For more interesting medical cases, check out our Diagnostic Dilemma archives.
This article is for informational purposes only and does not provide medical advice.
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