Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch

Antoinette van Laarhoven, Jens B Marker, Jesper Elberling, Gil Yosipovitch, Lars Arendt-Nielsen, Hjalte H Andersen

Research output: Contribution to journalReview articleResearchpeer-review

Abstract

As well-established for patients with chronic pain, patients suffering from chronic itch also exhibit signs of peripheral and central sensitization. This has been linked to parallel neuroplastic sensitization processes. However, for chronic itch, sensitization has not yet been systematically assessed, studied, and hence validated. This review (Prospero CRD42016043002) summarizes and meta-analytically evaluates whether sensory aberrations including sensitization for itch occur in chronic itch.Databases PubMed, Embase, and Cochrane Library were searched for studies investigating somatosensory sensitivity assessment by quantitative sensory testing stimuli, including experimental cutaneous chemical pruritic provocations, in patients with chronic itch from skin-/neurological conditions and compared with healthy controls. Outcomes were extracted for lesional and non-lesional skin and risk of biases were assessed. Meta-analyses were performed when sufficient quantitative data were available.Of 4,667 identified papers, 46 were included and 25 were eligible for meta-analyses. Patients (66% atopic dermatitis) were found more sensitive than the controls to histamine-evoked itch in lesional skin (SMD: 0.66 [CI: 0.16,1.15]), but not non-lesionally (SMD: -0.26 [CI: -0.58;0.06]). Cowhage did not evoke more itch in non-lesional skin of patients as compared to the controls (SMD: 0.38 [CI: -0.04,0.81]). For numerous other chemical provocations as well as for mechanical, thermal, and electrical stimulation paradigms, results were ambiguous or based on few studies.Patients with chronic itch are only robustly sensitized to various chemical pruritic stimuli when applied lesionally. More studies on somatosensory aberrations in chronic itch conditions other than atopic dermatitis are needed to establish whether sensitization is robustly present across chronic itch conditions.

Original languageEnglish
JournalPain
ISSN0304-3959
DOIs
Publication statusE-pub ahead of print - 10 Aug 2019

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Skin
Atopic Dermatitis
Meta-Analysis
Central Nervous System Sensitization
PubMed
Chronic Pain
Histamine
Electric Stimulation
Libraries
Hot Temperature
Databases

Cite this

van Laarhoven, Antoinette ; Marker, Jens B ; Elberling, Jesper ; Yosipovitch, Gil ; Arendt-Nielsen, Lars ; Andersen, Hjalte H. / Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch. In: Pain. 2019.
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title = "Itch sensitization?: A systematic review of studies using quantitative sensory testing in patients with chronic itch",
abstract = "As well-established for patients with chronic pain, patients suffering from chronic itch also exhibit signs of peripheral and central sensitization. This has been linked to parallel neuroplastic sensitization processes. However, for chronic itch, sensitization has not yet been systematically assessed, studied, and hence validated. This review (Prospero CRD42016043002) summarizes and meta-analytically evaluates whether sensory aberrations including sensitization for itch occur in chronic itch.Databases PubMed, Embase, and Cochrane Library were searched for studies investigating somatosensory sensitivity assessment by quantitative sensory testing stimuli, including experimental cutaneous chemical pruritic provocations, in patients with chronic itch from skin-/neurological conditions and compared with healthy controls. Outcomes were extracted for lesional and non-lesional skin and risk of biases were assessed. Meta-analyses were performed when sufficient quantitative data were available.Of 4,667 identified papers, 46 were included and 25 were eligible for meta-analyses. Patients (66{\%} atopic dermatitis) were found more sensitive than the controls to histamine-evoked itch in lesional skin (SMD: 0.66 [CI: 0.16,1.15]), but not non-lesionally (SMD: -0.26 [CI: -0.58;0.06]). Cowhage did not evoke more itch in non-lesional skin of patients as compared to the controls (SMD: 0.38 [CI: -0.04,0.81]). For numerous other chemical provocations as well as for mechanical, thermal, and electrical stimulation paradigms, results were ambiguous or based on few studies.Patients with chronic itch are only robustly sensitized to various chemical pruritic stimuli when applied lesionally. More studies on somatosensory aberrations in chronic itch conditions other than atopic dermatitis are needed to establish whether sensitization is robustly present across chronic itch conditions.",
author = "{van Laarhoven}, Antoinette and Marker, {Jens B} and Jesper Elberling and Gil Yosipovitch and Lars Arendt-Nielsen and Andersen, {Hjalte H}",
year = "2019",
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day = "10",
doi = "10.1097/j.pain.0000000000001678",
language = "English",
journal = "Pain",
issn = "0304-3959",
publisher = "International Association for the Study of Pain",

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Itch sensitization? A systematic review of studies using quantitative sensory testing in patients with chronic itch. / van Laarhoven, Antoinette; Marker, Jens B; Elberling, Jesper; Yosipovitch, Gil; Arendt-Nielsen, Lars; Andersen, Hjalte H.

In: Pain, 10.08.2019.

Research output: Contribution to journalReview articleResearchpeer-review

TY - JOUR

T1 - Itch sensitization?

T2 - A systematic review of studies using quantitative sensory testing in patients with chronic itch

AU - van Laarhoven, Antoinette

AU - Marker, Jens B

AU - Elberling, Jesper

AU - Yosipovitch, Gil

AU - Arendt-Nielsen, Lars

AU - Andersen, Hjalte H

PY - 2019/8/10

Y1 - 2019/8/10

N2 - As well-established for patients with chronic pain, patients suffering from chronic itch also exhibit signs of peripheral and central sensitization. This has been linked to parallel neuroplastic sensitization processes. However, for chronic itch, sensitization has not yet been systematically assessed, studied, and hence validated. This review (Prospero CRD42016043002) summarizes and meta-analytically evaluates whether sensory aberrations including sensitization for itch occur in chronic itch.Databases PubMed, Embase, and Cochrane Library were searched for studies investigating somatosensory sensitivity assessment by quantitative sensory testing stimuli, including experimental cutaneous chemical pruritic provocations, in patients with chronic itch from skin-/neurological conditions and compared with healthy controls. Outcomes were extracted for lesional and non-lesional skin and risk of biases were assessed. Meta-analyses were performed when sufficient quantitative data were available.Of 4,667 identified papers, 46 were included and 25 were eligible for meta-analyses. Patients (66% atopic dermatitis) were found more sensitive than the controls to histamine-evoked itch in lesional skin (SMD: 0.66 [CI: 0.16,1.15]), but not non-lesionally (SMD: -0.26 [CI: -0.58;0.06]). Cowhage did not evoke more itch in non-lesional skin of patients as compared to the controls (SMD: 0.38 [CI: -0.04,0.81]). For numerous other chemical provocations as well as for mechanical, thermal, and electrical stimulation paradigms, results were ambiguous or based on few studies.Patients with chronic itch are only robustly sensitized to various chemical pruritic stimuli when applied lesionally. More studies on somatosensory aberrations in chronic itch conditions other than atopic dermatitis are needed to establish whether sensitization is robustly present across chronic itch conditions.

AB - As well-established for patients with chronic pain, patients suffering from chronic itch also exhibit signs of peripheral and central sensitization. This has been linked to parallel neuroplastic sensitization processes. However, for chronic itch, sensitization has not yet been systematically assessed, studied, and hence validated. This review (Prospero CRD42016043002) summarizes and meta-analytically evaluates whether sensory aberrations including sensitization for itch occur in chronic itch.Databases PubMed, Embase, and Cochrane Library were searched for studies investigating somatosensory sensitivity assessment by quantitative sensory testing stimuli, including experimental cutaneous chemical pruritic provocations, in patients with chronic itch from skin-/neurological conditions and compared with healthy controls. Outcomes were extracted for lesional and non-lesional skin and risk of biases were assessed. Meta-analyses were performed when sufficient quantitative data were available.Of 4,667 identified papers, 46 were included and 25 were eligible for meta-analyses. Patients (66% atopic dermatitis) were found more sensitive than the controls to histamine-evoked itch in lesional skin (SMD: 0.66 [CI: 0.16,1.15]), but not non-lesionally (SMD: -0.26 [CI: -0.58;0.06]). Cowhage did not evoke more itch in non-lesional skin of patients as compared to the controls (SMD: 0.38 [CI: -0.04,0.81]). For numerous other chemical provocations as well as for mechanical, thermal, and electrical stimulation paradigms, results were ambiguous or based on few studies.Patients with chronic itch are only robustly sensitized to various chemical pruritic stimuli when applied lesionally. More studies on somatosensory aberrations in chronic itch conditions other than atopic dermatitis are needed to establish whether sensitization is robustly present across chronic itch conditions.

U2 - 10.1097/j.pain.0000000000001678

DO - 10.1097/j.pain.0000000000001678

M3 - Review article

JO - Pain

JF - Pain

SN - 0304-3959

ER -