Hives is a dermatological reaction to contact with water. Sufferers show swollen and itchy wheals on the skin after contact with water. Therapeutic options include the administration of antihistamines to relieve symptoms.
What is hives?
Hives is a dermatologic reaction. It is a skin reaction that the body produces when in contact with allergens. The skin reaction corresponds to dot-like, button-like or reddened wheals and erythema caused by allergic processes of the dermal blood vessels. Hives occur not only in connection with medications, food, psychological stress or immunological phenomena. The described symptoms may also occur as a reaction to contact with heat, light, pressure or water. Depending on the cause, medicine distinguishes different types of hives. Aquagenic hives is one of them. In this aquagenic form of urticaria, the skin reacts with a rash to exposure to water. The rash often develops seconds after contact and lasts on average about two hours. In addition to congenital forms of hives, acquired forms of the disease have been observed. Some patients report a slow resolution of symptoms over the course of their lifetime. Hives is a rather rare form of hives and was first described around the middle of the 20th century. Shelley and Rawnsley are believed to be the first describers. According to a British tabloid, only 35 cases were documented worldwide after the initial description.
Causes
Nettle rash is sometimes counted among allergies. However, this is not completely true. Allergies are characterized by the release of the neurotransmitter histamine, which causes the characteristic defensive reactions. Nettle rash is often associated with the release of histamine, but not in all cases. Therefore, it is probably not an actual water allergy, but rather a dermatologic reaction to substances such as chlorine or certain ions found in non-distilled water. Some of the cases documented to date suggest a genetic predisposition for hives. Thus, a familial clustering has sometimes been observed. The study of reactions in twin pairs is particularly suggestive of a genetic disposition. In addition to the genetic form of hives, however, there is apparently also a non-hereditary form, such as is assumed for the acquired types of hives. Since the majority of patients documented so far have been isolated cases without familial clustering, the sporadic occurrence of symptoms seems to be the more common variant. The causal relationships have not been conclusively clarified for this variant.
Symptoms, complaints, and signs
Patients of hives react to contact with water with symptoms similar to those caused by contact with stinging nettles. About 15 minutes after contact, whitish papules of small size appear at the sites of contact with the water and often persist for two hours. Accompanying symptoms are usually more or less severe itching. Slight reddening of the surrounding skin areas has also been observed in patients. Not every type of water has to trigger these reactions. Often, only rainwater leads to the skin changes. Other patients react exclusively to contact with seawater. However, some affected persons also report regular rashes after showering. Only in exceptional cases does the type of water not play a role in the reaction. The clinical picture of skin reactions may differ markedly from case to case. For example, in addition to the color changes and itching, some patients present with swelling, which is usually due to increased release of the neurotransmitter histamine. Whether and how much histamine patients release in contact with water differs from case to case.
Diagnosis and course of the disease
The diagnosis of hives is initially made by the physician through the patient’s medical history. To confirm such a tentative diagnosis based on the history, the patient is applied body-warm compresses that have been soaked with water. If the skin reactions described are then observed, the diagnosis is considered confirmed.The prognosis for patients is usually favorable. In many cases, absolute remission of the disease occurs during life.
Complications
In most cases, hives do not develop serious complications or cause serious discomfort. The symptoms can be treated relatively easily, so there is no permanent damage either. First and foremost, hives cause severe redness on the skin and itching. This can further increase if the patient scratches the skin. Furthermore, there may also be swelling on the skin. Many patients feel uncomfortable with the symptoms and thus suffer from a significantly reduced self-esteem and also from inferiority complexes. In children, this can lead to bullying or teasing, causing them to suffer from psychological symptoms. If the hives occur even with a simple contact with ordinary water, this can cause significant restrictions in the patient’s everyday life. As a rule, the symptoms of hives are treated with the help of medications. However, a complete and causal cure is not possible. Complications do not occur during treatment. Similarly, this disease does not reduce the life expectancy of the patient.
When should one go to the doctor?
In the case of hives, a visit to a doctor is necessary. In this disease, as a rule, there can be no self-healing, so early diagnosis and treatment always have a positive effect on the further course of the disease. A doctor should be contacted at the first symptoms and signs in order to prevent further complaints. A doctor should be consulted in case of hives if the affected person shows a very strong reddening on the skin after contact with water. In this case, severe itching also continues to occur, and the discomfort lasts for several hours. Similarly, swelling after contact may indicate hives and should be examined by a doctor. It is not uncommon for the color of the skin to change, indicating this disease. The initial diagnosis can be made by a general practitioner or an allergist. Treatment is not always necessary, so the further course depends very much on the severity of the symptoms. As a rule, hives does not reduce the life expectancy of the affected person.
Treatment and therapy
If the patient’s 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 medications weaken or even eliminate the effects of histamine by blocking the body’s own binding sites for histamine. Antihistamines are available for four different histamine receptors. Accordingly, the drugs are divided into H1, H2, H3 and H4 antihistamines. The H1 and H2 antihistamines show the most therapeutic effect and are considered the most relevant drugs in the treatment of allergies for this reason. If the skin reactions of patients with hives are not traceable to the action of the neurotransmitter histamine, symptomatic treatment with antihistamines remains unsuccessful. Sometimes a causal therapy of hives is considered in these patients. In this therapy, affected individuals are regularly exposed to distilled water until repeated exposure causes symptoms to resolve. However, this therapeutic option is not always crowned with success. Supportive therapy steps include, above all, extensive counseling of the patient. The affected person should adjust his or her daily routine to the disease and keep showering sessions as short as possible, for example.
Prevention
To date, no preventive measures are available for hives, as the correlations have not been conclusively clarified.
Aftercare
In most cases, direct aftercare measures for hives are significantly limited, so the affected person should seek professional medical care to prevent complications or other ailments from developing in the further course.A self-healing of this disease can usually not occur, so that the affected person should contact a doctor at the first symptoms or signs of hives. Most sufferers are dependent on taking medication that can alleviate and limit the symptoms. Here, the doctor’s instructions should always be followed, and the doctor should always be contacted first if there are any questions or if anything is unclear. Furthermore, the trigger of hives should be avoided if possible. Water contact, such as when showering, should be kept as short as possible to prevent the symptoms from recurring. Likewise, the underlying allergy should be treated to relieve the hives. Most sufferers also rely on their own family for help and care during treatment. The care can reduce the development of depression and other psychological upsets. As a rule, this disease does not limit or reduce the life expectancy of the affected person.
This is what you can do yourself
Although this disease is extremely rare, it can become a torment for those affected. This does not only concern the symptoms, the itching or the wheals after touching water, because this allergic reaction can be treated with antihistamines. But since the condition is usually hereditary, it affects patients from an early age. Unlike their schoolmates, they cannot play with water or go swimming carefree in the summer. This can lead to teasing and bullying. In these cases, psychological care is advisable. If the affected person reacts to all types of water, this can significantly reduce his quality of life. In this case, the patient must learn to cope with his situation: To use gloves when coming into contact with water, to wash briefly instead of taking a shower, etc. The symptoms of redness, swelling and itching are best relieved with cooling. Cooling gel pads, known commercially as Coolpads, are suitable for this purpose. They are available over the counter in pharmacies. Coolpads are best kept in the freezer compartment of the refrigerator and removed as needed. However, they should not be placed directly on the red, itchy areas because, on the one hand, they can also draw water and thus aggravate the symptoms. On the other hand, the application of cold Coopads can lead to cold burns. Therefore, the pads should be wrapped with a towel before application.
