Abstract
Aquagenic urticaria (AU) is a rare form of physical urticaria that is triggered by exposure to water. Despite its rarity, it can significantly impact patients' quality of life. The underlying pathophysiology of AU is not well-understood, but diagnosis is typically based on clinical history and confirmed by skin tests. Unfortunately, avoidance of the trigger is often impossible, making symptom control the primary approach to treatment.
 The lack of awareness and understanding of AU can make diagnosis and management challenging. Therefore, this case report highlights the clinical and etiological features of AU and emphasizes the need for improved management strategies.
 The patient in this case is a 15-year-old with a well-controlled asthma background treatment of fluticasone. Since age 7, the patient has experienced urticaria when exposed to both sea and fresh water. A diagnosis of aquagenic urticaria was confirmed through skin tests and patient history. Symptomatic treatment with antihistamines and barrier creams before swimming has been effective, with a limitation on the time spent in the water to manage symptom.
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