Aquagenic Urticaria in an Adolescent Following COVID-19 Vaccine

Abstract

A subset of patients receiving COVID-19 vaccinations develops cutaneous reactions. The majority are delayed hypersensitivity reactions that resolve spontaneously without treatment. More rarely, cutaneous manifestations such as urticaria, vasculitis, and morbilliform eruptions have been reported. Aquagenic urticaria is a form of chronic inducible urticaria caused by skin contact with water. Characteristic 1-2mm folliculopapular urticarial papules appear 20-30 minutes following water exposure and spontaneously resolve within 30-60 minutes of water removal. A water provocation test is the gold standard of diagnosis. The mainstay of treatment is 2nd generation H1 antihistamines taken before water exposure. We report the development of aquagenic urticaria in a 12-year-old African American male patient following the Pfizer-BioNTech mRNA COVID-19 vaccine.