Ever wonder if you could be allergic to everyday things such as water or the sun? As it turns out, you can. Alexandra Allen learned this unfortunate truth. At twelve years old, she broke out into welt-like hives after swimming. Perhaps the chlorine was an issue, but the following shower and antihistamines did nothing to help. It only got worse. After years of sporadic, seemingly random reactions to pools or lake water, she finally received a diagnosis – she was allergic to water.

The correct medical term is aquagenic urticaria. It is a form of physical urticaria (rashes caused by allergic reactions) that occurs when the skin comes into contact with any type of water (i.e. fresh, salt, tap, etc). It was first described in medical literature in the 1960s and is incredibly rare. Some research articles state less than one hundred cases have been diagnosed, while others state less than fifty.

Individuals with this disorder will notice a physical response whenever their skin touches water. Symptoms may be immediate or appear within thirty minutes of contact and include wheals (hives/welts), wheezing, and/or shortness of breath.

For people with this disorder, everything must now be approached with caution. Every day things such as bathing or being out in the rain are now sources of pain. In fact, your own sweat and tears could be cause for concern. As the disease progresses, sometimes drinking water, something needed for our survival, can result in swelling, the closing of the throat, and death.

So, what is there left to do? Unfortunately, given the rarity of aquagenic urticaria, it is poorly understood at this time. Researchers don’t even fully understand the cause. It is believed that aquagenic urticaria is an interaction between the water and a substance found either on the skin or in the body that generates a toxic material that the body then rejects, producing hives. Another hypothesis is closely related and believes that the interaction of water and an unknown substance triggers an immune response.

Without understanding the cause of the disease, treatment options are limited. Simple avoidance is impossible. It falls from the sky, is needed to live, and the body even produces it. People with this disorder have tried multiple things. Some individuals have used antihistamines, topical creams as a skin barrier, ultraviolet (UV) light therapy, and omalizumab (an injection usually used for people with severe asthma). Regrettably, there is no one-size-fits-all treatment. What works for one, might not work for another. There’s the potential that none of these options would work.

Luckily, researchers are still looking into the disease to help those affected. There is a familial case of aquagenic urticaria that is a potential avenue for researchers to understand genetic links. Researchers also wish to better understand the pathology of the disease to produce more effective therapies. Further education for medical professionals and the general population is also necessary as it is possible that it is underrecognized and underreported. Increased awareness could help provide a larger group for medical professionals to work with to provide more insight into the disease.