With many things that cause hives, patients are told to avoid the trigger. But water avoidance is just not realistic. That would mean forgoing bathing, not going outside when it is raining, and avoiding activities that cause sweat. So treatment with medications is often needed.
Antihistamines are often recommended. Doctors prefer second generation H1 antihistamines because they cause less drowsiness. (First-generation medications may work as well but may have more side effects such as drowsiness.) Additional treatment is often needed.
Topical medications are effective in many cases. Creams can help form a barrier between the skin and water. Patients are advised to apply a petroleum-based cream or an oil-in-water emulsion prior to water exposure.2
If oral antihistamines and topical treatments are not effective, there are other options. Phototherapy has been used to treat aquagenic urticaria successfully in some patients. In addition, talk with your doctor about other possible treatments such as the biologic omalizumab, steroid medications, or selective serotonin reuptake inhibitors (SSRIs).2
