Table 2.
Therapeutic options for aquagenic urticaria
| Therapeutic options | Line of therapy/notes | Proposed mechanism |
|---|---|---|
| Nonsedating, second-generation H1 antihistamines (eg, cetirizine) | First line at standard dose, second line consider dose increase up to fourfold | Antagonism or inverse agnosim of H1 receptor, preventing histamine effects |
| First-generation H1 antihistamines (eg, hydroxyzine) | Third line | Antagonism or inverse agnosim of H1 receptor, preventing histamine effects |
| H2 antihistamines (eg, cimetidine) | Third line | Unclear in urticaria, may have small additive effect with H1 antihistamines |
| Acetylcholine antagonists (eg, scopolamine) | Adjuvant with H1 antihistamines | May prevent histamine release |
| Phototherapy (eg, psoralen plus UVA, UVB) | Adjuvant with oral therapy or second-line alone | Reduction of mast cell activity, reactive thickening of the epidermis |
| Topical barrier creams (eg, petrolatum) | First line or adjuvant | Hydrophobic effect prevents water penetration into skin |
| Anabolic androgenic steroid (eg, stanozolol) | Case-specific, used in HIV patient with AU | Increases C1 esterase inhibitor synthesis |
| Selective serotonin reuptake inhibitors (eg, fluoxetine) | Case-specific, used in patient with extracutaneous symptom of AU | Unknown |
Note: Adapted from McGee JS, Kirkorian AY, Pappert AS, Milgraum SS. An adolescent boy with urticaria to water: Review of current treatments for aquagenic urticaria. Pediatr Dermatol. 2014;31(1):116–117. Copyright 2011 Wiley Periodicals, Inc.22
Abbreviations: AU, aquagenic urticaria; HIV, human immunodeficiency virus, UV, ultraviolet.