Aquagenic urticaria: presentation, diagnosis and management

Aquagenic urticaria, a rare dermatological condition characterised by urticarial eruptions following water contact, poses significant diagnostic and therapeutic challenges. This condition, although uncommon, necessitates heightened clinical awareness due to its substantial impact on the patient's quality of life. We present a comprehensive account of a paediatric case involving a girl in her mid-teens, who developed recurrent wheals post-exposure to water, independent of its temperature or source. Diagnosis hinged on a detailed clinical history and a definitive water provocation test, with routine laboratory assessments yielding no contributory findings. The therapeutic regimen featuring cetirizine yielded significant symptomatic relief. Although antihistamines are the cornerstone of treatment, the differential response among individuals necessitates an individualised approach, considering adjunctive treatments such as omalizumab and ultraviolet therapy. This case reinforces the critical role of clinical acumen in the recognition and diagnosis of aquagenic urticaria and calls for further research into its pathophysiology to refine treatment strategies.