My patient is a 44 year-old female who came to me for eval of four year history of chronic itching, worse sxs when she gets out of the shower, although sxs are present at other times of day. She has complicated medical hx significant for leukopenia/anemia, anxiety, SLE, Raynauds, sjogrens, migraine, neuropathy and asthma. She has h/o being high risk for BRCA. She has been treated with xyzal bid, Zyrtec, Claritin, allegra, Benadryl and hydroxyzine without relief. Labs including CBC (stable - WBC count 3.1), CMP, Fe studies, Vit B12, Folate, TSH and thyroid abs, tryptase were normal. Medications include trazodone, Benlysta, Symbicort, clonazepam, florinef, gabapentin, plaquenil, meloxicam, nabumetone, pantoprazole, Carafate, tamoxifen, topiramate, venlafaxine, prednisone 5-10 mg daily. She has been on Benlysta since 2013 and recalls having significant itching after first dose. Since then, she takes Benadryl as premedication and reports no increase in itching with further doses. My main question is- what further workup would you recommend? Also, could there be a question of Benlysta causing her ongoing itching?