Aquagenic Pruritis Without Urticaria

Bradley E. Chipps, MD, FCCP

November 14, 2003


I was interested in your previous Q&A on cholinergic urticaria. What about "aquagenic pruritus" without urticaria, when unbearable itching reaches a crescendo in the minutes after bathing? There are no skin changes, but the itching is accompanied by extreme agitation and eventually reluctance to get wet at all. How do you manage this? And the urticaria?

Response from Bradley E. Chipps, MD, FCCP

Aquagenic urticaria is a rare disorder associated with contact with water in which temperature is not a factor in the condition. Small papules appear with intense itching and occasionally cholinergic urticaria. Aquagenic urticaria is believed to have a similar mechanism similar to that of cholinergic urticaria. Pruritus may occur in the absence of a discrete rash. Treatment with H1-blockers, with or without an H2-blocker, is usually effective. Regular treatment is usually necessary. Other methods that may be tried include a leukotriene-receptor antagonist and on rare occasions an oral beta-agonist. This condition can be very difficult to control.