[5][6][7] The hives associated with aquagenic urticaria are typically small (approximately 1–3 mm), red- or skin-colored welts (called wheals) with clearly defined edges.

This theory suggests that a substance is formed by this interaction, the absorption of which causes perifollicular mast cell degranulation with release of histamine.

[23][24][25][26][27][13] Desensitization does not seem to work for aquagenic urticaria; a patient will continue to react to water no matter how gradually or frequently it is introduced.

[29] Oil in water emulsion creams, or petrolatum, applied as barrier agents prior to a shower or bath may control symptoms.

However, current recommendations suggest a trial of a second generation antihistamine up to four-times the standard dosing scheme for initial pharmacology.

For patients who cannot be controlled on high dose antihistamines, other therapeutics, including biologics like omalizumab, have shown improvements in case reports.