Related Experiment Videos
[Syncope during bathing in infants, a pediatric form of water-induced urticaria?]
O Mouterde1, E Mallet, J Spriet
1Centre de référence régional de recherche et prévention de la mort subite du nourrisson, hôpital Charles-Nicolle, Rouen, France.
Insights
Apparent life-threatening events in infants may be linked to aquagenic urticaria. This condition causes infants to become pale and unresponsive in water, but symptoms resolve quickly after removal.
Area of Science:
- Pediatric medicine
- Dermatology
- Allergy and immunology
Context:
- Apparent life-threatening events (ALTEs) pose diagnostic challenges in pediatrics.
- Sudden infant death syndrome (SIDS) risk complicates ALTE prognosis.
- A specific water-induced reaction in infants prompted investigation.
Purpose:
- To investigate a series of infants experiencing acute, severe reactions upon water immersion.
- To explore the potential link between these reactions and aquagenic urticaria.
- To identify clinical features and potential triggers for these pediatric "aquagenic maladies".
Summary:
- Eight infants (2-15 months) presented with pallor, hypotonia, and unresponsiveness upon water immersion, with rapid recovery.
- Family histories revealed dermographism and water/sun-related reactions in some members, suggesting an allergic or hypersensitivity link.
- Increased histamine levels post-bath in two infants and favorable outcomes after avoiding baths supported the aquagenic urticaria hypothesis.
Impact:
- Suggests "aquagenic maladies" may represent a pediatric manifestation of aquagenic urticaria.
- Highlights the importance of considering aquagenic urticaria in infants with unexplained water-related events.
- Informs clinical management by suggesting avoidance of water exposure as a therapeutic strategy.
Background:
Apparent life-threatening events in infants are a difficult and frequent problem in pediatric practice. The prognosis is uncertain because of risk of sudden infant death syndrome.
Case Reports:
Eight infants aged 2 to 15 months were admitted during a period of 6 years; they suffered from similar maladies in the bath: on immersion, they became pale, hypotonic, still and unreactive; recovery took a few seconds after withdrawal from the bath and stimulation. Two diagnoses were initially considered: seizure or gastroesophageal reflux but this was doubtful. The hypothesis of an equivalent of aquagenic urticaria was then considered; as for patients with this disease, each infant's family contained members suffering from dermographism, maladies or eruption after exposure to water or sun. All six infants had dermographism. We found an increase in blood histamine levels after a trial bath in the two infants tested. The evolution of these "aquagenic maladies" was favourable after a few weeks without baths. After a 2-7 year follow-up, three out of seven infants continue to suffer from troubles associated with sun or water.
Conclusion:
"Aquagenic maladies" could be a pediatric form of the aquagenic urticaria.