Allergic Diseases, S.C. Steven H. Cohen, M.D.
Home Doctor First Visit Office Policies Medical Info Asthma Allergies Bronchodilators Stinging Insects Itch Cough Allergy Vaccine Therapy Mold Clinical Trials Contact Us FAQs Links	The Story of Itch “An itch demands a scratch, but science has barely begun to scratch the surface of why an itch itches, and how to make it stop.” So begins Abigail Zuger in her article entitled “The Mystery of Itch, the Joy of Scratch”, originally published in the New York Times on July 1, 2003. As Ms. Zuger explains, the “itch-scratch” cycle has been an under-funded area of research, although it can cause severe discomfort, scarred skin and sleepless nights for the many people who suffer from itch. Itch has begun to attract international scientific attention. The International Forum for the Study of Itch is a multidisciplinary international association of clinical practitioners, researchers and scientists dedicated to improving the understanding and treatment of itch, according to their web site. The Forum is currently being developed in order to advance itch-related research and education and to promote treatment and clinical efforts to help alleviate this debilitating symptom. The dictionary defines itch as an irritating sensation causing a desire to scratch; any of various skin disorders, such as scabies, marked by intense irritation and itching; a restless desire or craving for something. The sensation of itchiness can be caused by many things including the movement of hairs on the skin or the release of a chemical called histamine from cells in the skin. Histamine is released from mast cells in the skin in response to a histamine trigger, such as exposure to an allergen. Histamine binds to local nerve endings on specific receptors, and is the chemical that causes the itch and reddening of the skin when an insect bites. The histamine-induced itch travels via the spinothalamic tract in fibers specific for itch. There are many causes of itch including conditions such as psoriasis, eczema, sunburn and insect bite, jaundice, infection with lice or worms, medication allergy and medication side effect (ex. morphine). Not all itch is histamine-mediated. Therefore, treatment can be sketchy and ineffective. Antihistamines do help in those cases where histamine is involved (mosquito bites, allergic skin reactions), but in other cases these medications do not work. There are many anti-itch remedies on the market. Some people may get relief from antibiotic creams, skin moisturizers or drugs which suppress the immune system such as steroids. Others, such as those suffering from liver or kidney disease, may find no relief at all. If you spend a few moments surfing the web you’ll encounter any number of so-called itch remedies from herbs to electronic itch stoppers. Chronic itchers would be only so happy if some of these things worked. A case mentioned in Ms. Zuger’s article describes a woman with liver disease who was so miserable from intractable itching that she almost received a liver transplant. Since some studies have shown that intractable itch can sometimes be helped by drugs that are usually used to counteract the effects of morphine, this woman was given opioid blocking medication, and her itch subsided completely. The mechanism of action in this case is thought to be related to the fact that in some people itch may be caused in part by too many natural opioid molecules circulating in the brain. From an allergist’s perspective, itch has a central place in a patient’s litany of complaints. Allergy sufferers may be welcoming the upcoming cold weather as a reprieve from their symptoms. However, there is an itchy condition which may occur with cold weather called Cold-Induced Urticaria. This type of skin condition is triggered by a rapid change in temperature, which is why winter, with its fluctuating temperatures, is the prime season for this to occur. Hives are caused by the release of histamine when skin is exposed to cold temperatures and also when the skin is warmed after exposure to the cold. The skin starts to itch, turn red and swell within minutes. Prolonged exposure of a large part of the body may result in wheezing, flushing and even fainting due to the larger quantities of histamine produced. The itch associated with urticaria can be extreme. Other causes of this condition may be the immune system’s overreaction to certain foods, drugs, infection, insect stings, blood transfusions or other substances. Common triggers of hives include foods such as eggs, nuts and shellfish, and drugs such as penicillin. If a cause can be identified, avoidance is the best option. Itch is not only a medical condition. It’s a human phenomenon. The following quotes reflect some peoples’ thoughts on itch. “One learns to itch where one can scratch.” Scott Reed “When once the itch of literature comes over a man, nothing can cure it but the scratching of a pen. But if you have not a pen, I suppose you must scratch any way you can.” Samuel Lover “The urge to write poetry is like having an itch. When the itch becomes annoying enough, you scratch it.” Robert Penn Warren “But when the pen is in his hand he has to write by itch and twitch, though certainly his itch and twitch are intimately conditioned by all his past itching and twitching, and by all his past theorizing about them.” John Ciardi “I base most of my fashion taste on what doesn’t itch.” Gilda Radner “Happiness is having a scratch for every itch.” Ogden Nash Finally, I’d like to share the following poem I came across while researching this most twitchy topic. An Itch Have you ever gotten an itch? Of course you have, we all do But have you ever gotten one Inside of your shoe? On the top of your foot Or worse—on the bridge? Because the top is more flexible But there is rubber on that ridge Have you ever felt the urge As your skin seems to seethe To take off your shoe And have some relief? Why does that happen When you know quite well That taking off your shoe Will make others complain of the smell Even if your feet aren’t smelly It’s considered impolite To take off your shoe In plain sight So you bang your foot against the leg of a chair Or try to rub it with your other shoe Or try to reach it discreetly with your pen At least, that’s what I do But sometimes an itch just can’t be reached Unless you remove the enclosure You have to decide whether or not You’ll allow it that exposure Now you’re probably thinking Whether or not you would, Well let me just tell you It feels really good. Anna Crisologo      11121 W. Oklahoma Avenue    West Allis, WI 53227    Tel: 414.545.1111