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PRIMARY NOCTURNAL ENURESIS IN CHILDREN WITH ALLERGIC RHINITIS AND SEVERE ADENOTONSILLAR HYPERTROPHY: A SINGLE CENTER
1Unit of Pediatric Nephrology and Rheumatology, University of Messina, Messina, Italy.
Insights
Children with allergic rhinitis and severe nasal congestion are more likely to experience primary nocturnal enuresis (bedwetting). This suggests a link between respiratory issues and bedwetting in children.
Area of Science:
- Pediatric Allergy and Immunology
- Pediatric Urology
- Sleep Medicine
Background:
- Nocturnal enuresis (bedwetting) is common in children and often multifactorial.
- Allergic rhinitis is a prevalent condition in pediatrics, impacting quality of life.
- The relationship between allergic rhinitis severity and nocturnal enuresis requires further investigation.
Purpose of the Study:
- To investigate the association between allergic rhinitis, adenoidal hypertrophy severity, and primary nocturnal enuresis in children.
- To compare the incidence of primary nocturnal enuresis in children with mild versus severe allergic rhinitis and adenoidal hypertrophy.
Main Methods:
- Retrospective and prospective case series of 59 children diagnosed with allergic rhinitis.
- Children were categorized into two groups based on adenoidal hypertrophy severity (Grade I-II vs. Grade III-IV).
- Diagnosis of allergic rhinitis included nasal symptoms, skin prick testing, and serum IgE levels. Primary nocturnal enuresis history was recorded.
Main Results:
- A significantly higher prevalence of primary nocturnal enuresis was observed in children with severe adenoidal hypertrophy (Grade III-IV) (22.22%) compared to those with mild hypertrophy (Grade I-II) (3.12%) (p=0.040).
- No significant differences were found in atopic sensitization or serum total IgE levels between the groups.
- This suggests that respiratory compromise severity, rather than atopy markers alone, may influence nocturnal enuresis.
Conclusions:
- Allergic rhinitis, particularly with significant respiratory manifestations like severe adenoidal hypertrophy, may contribute to the development of primary nocturnal enuresis in children.
- Potential multifactorial causes include sleep-disordered breathing, chronic inflammation, and immune dysregulation.
- Further research into the interplay of allergic rhinitis, sleep, and enuresis is warranted.
Abstract:
Nocturnal enuresis is defined as intermittent urinary incontinence during sleep that occurs at least twice a week for three consecutive months. There is no unifying etiology for nocturnal enuresis in the pediatric population and the disorder is likely to be multifactorial. We aimed to investigate the relationship between primary nocturnal enuresis, allergic rhinitis, and related complications in a paediatric case series from a single Center. We retrospectively reviewed and prospectively followed-up at our Institution (i) 32 children (14 females, 18 males; mean age 6.31±1.21 yrs) affected by allergic rhinitis with adenoidal hypertrophygrade I-II (group A) and (ii) 27 children (11 females, 16 males; mean age 6.52±1.33 yrs) affected by allergic rhinitis with adenoidal hypertrophy grade III-IV (group B). Allergic rhinitis was diagnosed on the basis of (a) typical nasal symptoms due to atopic sensitization (e.g., rhinorrhea , itching, sneezing fits, and nasal congestion and obstruction) and (b) positive skin prick testing and/or increased level of total serum IgE. We identified discrepancies between group A and group B in terms of risk of primary nocturnal enuresis. In fact, only 1 child of group A (3.12%) reported uncomplicated primary nocturnal enuresis; conversely, 6 children of group B (22.22%) showed a history of uncomplicated primary nocturnal enuresis (p=0.040). There was no statistically significant difference between the two groups in terms of atopic sensitization and serum total IgE levels (p=0.43). Allergic rhinitis may potentially influence the onset and the natural history of nocturnal enuresis in some children. Children with allergic rhinitis and more severe respiratory manifestations, seem to be more prone to developing primary nocturnal enuresis, likely due to potential multi-factorial causes (e.g., sleep disorders, chronic phlogosis, immune deregulation).
