Aquagenic urticaria in complete remission after starting omalizumab

Published Online: February 3, 2016

Aquagenic urticaria (hives) is a rare form of physical hives triggered by skin exposure to water regardless of the source, temperature or salinity. The hives and accompanying intense itching typically develop within 20-30 minutes after exposure and resolve within 30-60 minutes after drying. This condition has a substantial impact on patients’ quality of life as simple activities of daily living, such as bathing or walking in rain, may result in excruciating symptoms. Due to the rarity of this condition, evidence-based treatments are lacking.  Antihistamines are the cornerstone of therapy, although with varying reported efficacy.

In a report recently published in The Journal of Allergy and Clinical Immunology: In Practice, Rorie and Gierer describe a patient with a 2 year history of aquagenic urticaria refractory to high dose antihistamine therapy. Due to persistent hives despite traditional therapies and an obvious inability to avoid contact with water, a trial of omalizumab was initiated.

Shortly after receiving the initial dose of omalizumab, the patient reported complete remission of urticaria with all water exposure and has been able to discontinue all antihistamines. The authors believe this may be the first reported case of successful remission of aquagenic urticaria with omalizumab. The authors conclude that a trial of omalizumab may be warranted as a safe and effective treatment option in antihistamine refractory aquagenic urticaria.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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