- Why another thread? What's wrong with the earlier one/s?
- From the latest articles I could find (2009 and 2010):
http://dx.doi.org/10.1590/S0365-05962009000500015
http://www.jiaci.org/issues/vol20issue7/vol20issue07-17.htm
The pathogenesis of this form of urticaria has not been fully clarified; many mechanisms have been proposed. In 1964, Shelley and Rawnsley suggested that water interacted with components of the corneal strata or sebaceous glands to form a toxic substance that would be absorbed by the skin, resulting in degranulation of perifollicular mast cells and histamine release, which would result in urticarial lesions.1 Czarnetzki et al.11 suggested that there was a water-soluble antigen on the epidermis that, in contact with water, would diffuse throughout the dermis, causing mast cells to release histamine, which appears to be the chemical mediator in the pathogenesis of aquagenic urticaria. Other mediators, such as acetylcholine, serotonin, and bradikynin may also be involved in the pathogenesis of aquagenic urticaria. - Exploring the pathophysiology is of questionable value, because there are so few people who suffer from it, and experimenting on them isn't nice. Eg see http://dx.doi.org//10.1034/j.1600-0536.2001.44020912.x:
The sea water as is, the ultrafiltered seawater and the hypertonic saline solution elicited intense erythema, scattered with distinct small wheals, after 20 min of contact with the skin of the mandibular and submandibular region. Localized pruritus and discomfort were severe. The rash cleared spontaneously within 60 min. Tap water elicited patchy erythema and mild discomfort, while distilled water elicited only a tiny follicular wheal and no subjective symptoms. Control tests in the antecubital fossae were all negative. Sorbic acid 5% pet. caused intense erythema and a burning sensation, but no whealing. Petrolatum as is had no effect.
It was not possible to investigate the urticant effect of ethanol, acetone or a hypertonic non-ionic water solution, such as a glucose solution, because the patient refused to undergo further testing. - There's not necessarily a single answer. The specific cause might be different in different people.
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