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Vol. 135, No. 2, 2004
Issue release date: October 2004
Int Arch Allergy Immunol 2004;135:166–172
(DOI:10.1159/000080898)

Itch: More than Skin Deep

Greaves M.W. · Khalifa N.
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Abstract

Recent research in neurophysiology of itch has indicated the existence of itch-dedicated nociceptor neurones. The perception of itch is regulated by tonically inhibitory descending neuronal pathways and nociceptor spinal neuronal circuits. There is at present no convincing evidence of an ‘itch centre’ in the brain. A classification of itch has been proposed, based on neurophysiological considerations, which stresses the importance of neurogenic and neuropathic itch, and assists in differential diagnosis and selection of treatment. However, more than one class of itch can occur concurrently in the same patient. The importance of cross- talk between dermal mast cells and nociceptor nerve terminals, involving cleavage of proteinase-activated receptor 2 by mast cell tryptase, is highlighted. The pruritus of cholestasis is mediated at least in part by opioid peptides synthesized by the liver, and elevated levels of these mediators are found in the plasma and skin of patients with itch due to cholestasis. The combined use of both µ- receptor antagonists and ĸ-receptor agonists (anti-pruritic) is worth exploring.



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