Dr David L. J. Freed, MB, MD, MIBiol
These four case remind me how many patients can react adversely to water, finding that some brands of mineral water suit them but not others.
ALLERGY TO WATER
This 29-year-old American airman, was stationed at Menwith Hill radar station and consulted me in Harrogate, with a history of intense itching of the skin, followed by sloughing, after any intense exercise or any exposure to tap water. The differential diagnosis was between cholinergic and aquagenic urticaria.
Aquagenic pruritus was first described 20 years ago by Greaves, a conventional dermatologist, whose observation, accurate and correct though it was, brought down the scorn of his conventional colleagues (surprise surprise) onto his head, The existence of the condition remains controversial though it is supported by a substantial body of learned literature [12]. Many dermatologists do accept its existence. As implied by the name, it is a pruritus, with or without an urticarial rash,, caused by bathing or showering. Cold and hot waters are equally implicated, ii, some cases even distilled water, Pathogenesis - unknown.
Tap water is far from the pure H20 that the water companies would like us to believe. (Indeed, not even distilled water is 100% pure). I inherited an elderly freeze-drier from my old University department and though it wheezes a bit it still works (sometimes), and I have been interested in freeze-drying tap water to see what solids remain behind. In Manchester one litre yields 50-100 mg of brown powder, which when diluted and used as a skin-test reagent produces positive immediate or delayed reactions in many allergy patients, especially those with atopic eczema. London water gives twice that much sediment but it’s white.
This man had served in many overseas countries as part of his duties and had experienced the same problem in the USA. UK, Korea and Japan.
I had no freeze-dried Harrogate tap water available so I attempted to desensitise him against Manchester water, using the neutralisation technique, in the hope that there would be enough similarity to provide some protection. There were no reactions at any dilution, either immediate or delayed, so following my usual policy I issued the no.2 dilution as treatment. At the same time I gave the commonsense instructions always given for aquagenic pruritus - avoid soaking in a hot bath, just have quick cool give yourself a final rinse with cool filtered water etc. A month later he rang to report he was feeling quite a bit better, though he thought that was mainly because of the avoidance manoeuvres rather than the jabs. I was inclined to agree.
He was still suffering so I freeze-dried some Harrogate water and tried that. This time there was a convincing type I reaction at the higher strengths tested, and he neutralised well on the 5th dilution (that is, considerably weaker than the native tap water itself). He rang next day to report a dramatic improvement, and he was happy for a few weeks but then the problem returned, though not as severely.
He was now suffering severely from a problem that he had mentioned before but which had been eclipsed at the time by the main problem: sweat made him itch! Although his was a desk job, he was expected like all servicemen to keep himself physically trim by regular workouts in the gym, but he was inhibited from that because exercise made him sweat and his own sweat made him itch. He was failing his fitness tests and his job was now in jeopardy. I was at a loss, but pursuing the original line of thinking. I started wondering whether he might be excreting allergens in his own sweat (derived from the food or any other source), in sufficient amounts to cause a local reaction. I asked him to collect some of his sweat in a bottle and on his next attendance he presented me with about 1ml of a liquid which he claimed was his sweat.
Feeling thoroughly surreal. I diluted out this liquid and skin—tested him. To my intense gratification he produced a big skin reaction to the first three dilutions and a beautiful neutraliser to the fifth. Typical, I had left my camera behind (shades of the Loch Ness Monster!) but did manage a couple of rather fuzzy snapshots using a borrowed camera. There was not enough of the sample to provide more than a few days worth of injections but he tried those, alas without improvement (if sweat does indeed contain diet-derived allergens. presumably its allergenic composition varies from day to day, like mother’s milk).
My next step would have been to start him on my comprehensive programme, with neutralisation for a wide range of substances and an elimination/rotation diet, but sadly his insurance cover now ran out and he did not return to see me. I gather he left the Air Force and the county and I have no satisfactory ending for this fascinating tale.
REFERENCES
1) Greaves MW, Black EK et al:
Aquagenic pruritus.
Br MedJ (1981)282: 2008-10
2) Anonymous editorial:
Bath-time itch.
Ibid. 1995-6
The following cases are not mine, but come from Dr Stewart Morison.
NEVER MIND THE CHLORINE!
A 50 year old hotelier’s wife in Jersey had had severe perennial rhinitis, asthma, lBS. and chronic fatigue for many years. Depressed and suspicious of any ‘new’ treatments - she had tied several before - she could justify the label of being a ’wreck’!
At that time, I was still using incremental desensitisation, and offered her a trial of this, including a few foods to which she knew she was particularly sensitive, intending to neutralise her to more foods and chemicals later as the need arose.
Much to my surprise - and hers! - all her problems resolved about two-thirds of the way through the course, although she needed maintenance doses once a week to sustain this improvement.
But one problem remained: she could happily drink heavily chlorinated mains water, but could not tolerate her own sweet borehole water at home, which was not on mains water. She could not tolerate most bottled mineral waters that she had tried.
This dilemna was finally resolved by buying 5 gallon containers, which she filled at work (which was on mains water) taking it home with her in her car boot as her ‘main’ source of drinking water!
I still find this truly bizarre.
Dr Stewart Morison.
“HOME SWEET HOME”!
When we first moved to our currant address, I was appalled to find “things floating in our tap water! It tasted foul and! was obliged to start buying bottled mineral water for the first time in my life.
This problem was quickly resolved by fitting a Fresh Water Filter Company filter with an extra tap on the kitchen sink -thank you Dwight! - but I then began to itch after having a bath. This was further resolved by fitting a whole house filter from the same company, and all was well for a time.
Our youngest daughter returned home from an extended tip to India, and a soon had her first bath she also complained of itching of the skin. When I developed CFS, once again I itched after every bath, until I was neutralised to a range of other items to which, I had become sensitised Now all is well again for me, but Emily still itches whenever she has a bath in this house.
Dr Stewart Morison.
AN ONGOING PROBLEM
One of my long-term patients, who is neutralised to just about everything we can think of, still has a problem with almost all drinking water she has tried.
Her home is ‘covered’ with a whole house filter and a drinking water filter, and she is now all right when washing - she previously itched badly due to the chlorine to which she is very sensitive, even when she is correctly neutralised to it -but she had not been able to drink any water at all without feeling ill.
Recently, she was admitted to hospital, and to everyone’s surprise - not least hers! - she found that she was able to drink the water in the hospital without ill effect.
So the latest plan is for than to collect water from the hospital for drinking at home, if this is feasible.
In case it isn’t - or it doesn’t work - does anyone have any other suggestions?
Dr Stewart Morison.
