Alloknesis and hyperknesis: mechanisms, assessment methodology, and clinical implications of itch sensitization

Hjalte Holm Andersen, Tasuka Akiyama, Leigh Ann Nattkemper, Antoinette I. M. van Laarhoven, Jesper Elberling, Gil Yosipovitch, Lars Arendt-Nielsen

Publikation: Bidrag til tidsskriftReview (oversigtsartikel)Forskningpeer review

10 Citationer (Scopus)
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Resumé

Itch and pain share numerous mechanistic similarities. Patients with chronic itch conditions (for instance atopic dermatitis or neuropathic itch), often experience symptoms such as mechanical alloknesis and hyperknesis. These dysesthesias are analoguous to the pain-associated phenomena allodynia and hyperalgesia, which are often observed, e.g., in neuropathic pain conditions. Mechanical itch dysesthesias represent abnormal sensory states (caused by neuroplastic changes) wherein considerable itch is evoked, for instance by light cutaneous stimuli such as from clothing (alloknesis), or where increased itch is perceived in response to normally itch-evoking stimuli (hyperknesis). These itch sensitization phenomena have been explored in experimental human studies, observed in chronic itch patients, as well as in animal models of itch. Limited attention has been paid to these sensory phenomena in clinical studies, and it is unknown how they respond to antipruritics. Psychophysical quantitative sensory testing can quantify the presence, severity, and spatial extent of itch dysesthesias in chronic itch patients, providing a proxy of itch sensitization. This review outlines current assessment techniques, knowledge on the mechanisms of mechanical allo- and hyperknesis, and presents the diverse results derived from clinical studies exploring the presence of itch dysesthesias in chronic itch patients. Whereas a major role of quantitative sensory testing and neuronal sensitization in patients with chronic pain is accepted and utilized in the clinical assessment, the exact mechanisms, and potential clinical implications of itch sensitization in itch patients remains to be evaluated.
OriginalsprogEngelsk
TidsskriftPain
Vol/bind159
Udgave nummer7
Sider (fra-til)1185–1197
ISSN0304-3959
DOI
StatusUdgivet - 1 jul. 2018

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Paresthesia
Hyperalgesia
Antipruritics
Pain
Clothing
Neuralgia
Proxy
Atopic Dermatitis
Chronic Pain
Animal Models
Light
Skin
Clinical Studies

Citer dette

Andersen, H. H., Akiyama, T., Nattkemper, L. A., van Laarhoven, A. I. M., Elberling, J., Yosipovitch, G., & Arendt-Nielsen, L. (2018). Alloknesis and hyperknesis: mechanisms, assessment methodology, and clinical implications of itch sensitization. Pain, 159(7), 1185–1197. https://doi.org/10.1097/j.pain.0000000000001220
Andersen, Hjalte Holm ; Akiyama, Tasuka ; Nattkemper, Leigh Ann ; van Laarhoven, Antoinette I. M. ; Elberling, Jesper ; Yosipovitch, Gil ; Arendt-Nielsen, Lars. / Alloknesis and hyperknesis : mechanisms, assessment methodology, and clinical implications of itch sensitization. I: Pain. 2018 ; Bind 159, Nr. 7. s. 1185–1197.
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abstract = "Itch and pain share numerous mechanistic similarities. Patients with chronic itch conditions (for instance atopic dermatitis or neuropathic itch), often experience symptoms such as mechanical alloknesis and hyperknesis. These dysesthesias are analoguous to the pain-associated phenomena allodynia and hyperalgesia, which are often observed, e.g., in neuropathic pain conditions. Mechanical itch dysesthesias represent abnormal sensory states (caused by neuroplastic changes) wherein considerable itch is evoked, for instance by light cutaneous stimuli such as from clothing (alloknesis), or where increased itch is perceived in response to normally itch-evoking stimuli (hyperknesis). These itch sensitization phenomena have been explored in experimental human studies, observed in chronic itch patients, as well as in animal models of itch. Limited attention has been paid to these sensory phenomena in clinical studies, and it is unknown how they respond to antipruritics. Psychophysical quantitative sensory testing can quantify the presence, severity, and spatial extent of itch dysesthesias in chronic itch patients, providing a proxy of itch sensitization. This review outlines current assessment techniques, knowledge on the mechanisms of mechanical allo- and hyperknesis, and presents the diverse results derived from clinical studies exploring the presence of itch dysesthesias in chronic itch patients. Whereas a major role of quantitative sensory testing and neuronal sensitization in patients with chronic pain is accepted and utilized in the clinical assessment, the exact mechanisms, and potential clinical implications of itch sensitization in itch patients remains to be evaluated.",
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Andersen, HH, Akiyama, T, Nattkemper, LA, van Laarhoven, AIM, Elberling, J, Yosipovitch, G & Arendt-Nielsen, L 2018, 'Alloknesis and hyperknesis: mechanisms, assessment methodology, and clinical implications of itch sensitization' Pain, bind 159, nr. 7, s. 1185–1197. https://doi.org/10.1097/j.pain.0000000000001220

Alloknesis and hyperknesis : mechanisms, assessment methodology, and clinical implications of itch sensitization. / Andersen, Hjalte Holm; Akiyama, Tasuka; Nattkemper, Leigh Ann; van Laarhoven, Antoinette I. M.; Elberling, Jesper; Yosipovitch, Gil; Arendt-Nielsen, Lars.

I: Pain, Bind 159, Nr. 7, 01.07.2018, s. 1185–1197.

Publikation: Bidrag til tidsskriftReview (oversigtsartikel)Forskningpeer review

TY - JOUR

T1 - Alloknesis and hyperknesis

T2 - mechanisms, assessment methodology, and clinical implications of itch sensitization

AU - Andersen, Hjalte Holm

AU - Akiyama, Tasuka

AU - Nattkemper, Leigh Ann

AU - van Laarhoven, Antoinette I. M.

AU - Elberling, Jesper

AU - Yosipovitch, Gil

AU - Arendt-Nielsen, Lars

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Itch and pain share numerous mechanistic similarities. Patients with chronic itch conditions (for instance atopic dermatitis or neuropathic itch), often experience symptoms such as mechanical alloknesis and hyperknesis. These dysesthesias are analoguous to the pain-associated phenomena allodynia and hyperalgesia, which are often observed, e.g., in neuropathic pain conditions. Mechanical itch dysesthesias represent abnormal sensory states (caused by neuroplastic changes) wherein considerable itch is evoked, for instance by light cutaneous stimuli such as from clothing (alloknesis), or where increased itch is perceived in response to normally itch-evoking stimuli (hyperknesis). These itch sensitization phenomena have been explored in experimental human studies, observed in chronic itch patients, as well as in animal models of itch. Limited attention has been paid to these sensory phenomena in clinical studies, and it is unknown how they respond to antipruritics. Psychophysical quantitative sensory testing can quantify the presence, severity, and spatial extent of itch dysesthesias in chronic itch patients, providing a proxy of itch sensitization. This review outlines current assessment techniques, knowledge on the mechanisms of mechanical allo- and hyperknesis, and presents the diverse results derived from clinical studies exploring the presence of itch dysesthesias in chronic itch patients. Whereas a major role of quantitative sensory testing and neuronal sensitization in patients with chronic pain is accepted and utilized in the clinical assessment, the exact mechanisms, and potential clinical implications of itch sensitization in itch patients remains to be evaluated.

AB - Itch and pain share numerous mechanistic similarities. Patients with chronic itch conditions (for instance atopic dermatitis or neuropathic itch), often experience symptoms such as mechanical alloknesis and hyperknesis. These dysesthesias are analoguous to the pain-associated phenomena allodynia and hyperalgesia, which are often observed, e.g., in neuropathic pain conditions. Mechanical itch dysesthesias represent abnormal sensory states (caused by neuroplastic changes) wherein considerable itch is evoked, for instance by light cutaneous stimuli such as from clothing (alloknesis), or where increased itch is perceived in response to normally itch-evoking stimuli (hyperknesis). These itch sensitization phenomena have been explored in experimental human studies, observed in chronic itch patients, as well as in animal models of itch. Limited attention has been paid to these sensory phenomena in clinical studies, and it is unknown how they respond to antipruritics. Psychophysical quantitative sensory testing can quantify the presence, severity, and spatial extent of itch dysesthesias in chronic itch patients, providing a proxy of itch sensitization. This review outlines current assessment techniques, knowledge on the mechanisms of mechanical allo- and hyperknesis, and presents the diverse results derived from clinical studies exploring the presence of itch dysesthesias in chronic itch patients. Whereas a major role of quantitative sensory testing and neuronal sensitization in patients with chronic pain is accepted and utilized in the clinical assessment, the exact mechanisms, and potential clinical implications of itch sensitization in itch patients remains to be evaluated.

U2 - 10.1097/j.pain.0000000000001220

DO - 10.1097/j.pain.0000000000001220

M3 - Review article

VL - 159

SP - 1185

EP - 1197

JO - Pain

JF - Pain

SN - 0304-3959

IS - 7

ER -

Andersen HH, Akiyama T, Nattkemper LA, van Laarhoven AIM, Elberling J, Yosipovitch G et al. Alloknesis and hyperknesis: mechanisms, assessment methodology, and clinical implications of itch sensitization. Pain. 2018 jul 1;159(7):1185–1197. https://doi.org/10.1097/j.pain.0000000000001220