Itch is one of the most commonly encountered symptoms in allergy clinics. Until recently, effective therapies for itch were limited, but now there are multiple classes of drugs that can target distinct forms of itch. Despite this remarkable progress, variability in therapeutic outcomes underscores unmet needs in treating pruritic skin diseases. As a paradigm of neuroimmune crosstalk, insight into basic mechanisms of itch may shed new light on conditions beyond the skin. This article discusses basic preclinical scientific studies of itch neuroimmunology and how approved medications for pruritic skin diseases are informing development of the next generation of treatments.