A patient who has chronic asthma says her chin itches whenever she coughs or wheezes. What might cause this?
—Ronald Hirsch, MD, Elgin, Ill.

Interesting question! Facial itching has been reported as a result of histamine release and as a known side effect of opioid administration. In the latter case, opioid receptors in the medullary dorsal horn have been postulated as causal. I suspect humoral factors related to your patient’s asthma are triggering the reaction. If she has disabling chin pruritus, a trial of an antihistamine or leukotriene inhibitor might be of benefit; otherwise, your patient has another marker of asthma control that she can follow.
—R. Steven Tharratt, MD, MPVM (115-15)

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