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Nocturnal enuresis in children with allergic disease: prevalence, phenotype, and ARIA severity analysis
Şefika İlknur Kökçü Karadağ1, Bahar Eda Küçük2, Aslı Berivan Topçak3
1Department of Pediatric Allergy and Immunology, Prof. Dr. Cemil Taşcıoğlu City Hospital, Kaptan Paşa, Okmeydanı No:25, 34384, Şişli, Istanbul, Turkey. drilknurkokcu@gmail.com.
Insights
Primary nocturnal enuresis (PNE) is more common in children with allergies, who also show distinct symptoms like sleep disturbance. Allergy evaluation is recommended for children with PNE.
Area of Science:
- Pediatric Allergy and Immunology
- Pediatric Nephrology
- Sleep Medicine
Background:
- Primary nocturnal enuresis (PNE) affects a significant number of children.
- Allergic diseases are common in childhood and may influence other health conditions.
- The relationship between allergic diseases and PNE requires further investigation.
Purpose of the Study:
- To determine the prevalence of PNE in children with allergic disease.
- To characterize the allergic symptom burden in children with PNE.
- To identify clinical phenotype differences between allergic and nonallergic enuretic children.
Main Methods:
- 300 children aged 5-18 years were enrolled into three groups: allergic disease cohort (n=100), PNE cohort (n=100), and a general pediatric comparison group (n=100).
- Clinical phenotypes were systematically compared between allergic enuretic children and enuretic children from the comparison group.
- Allergic Rhinitis and its Impact on Asthma (ARIA) classification was used to assess allergic rhinitis severity.
Main Results:
- PNE prevalence was 1.7-fold higher in allergic children (27.0%) compared to the control group (16.0%).
- Allergic enuretic children exhibited shorter enuresis duration, higher nocturnal sleep disturbance, and lower rates of stress-related exacerbation.
- The PNE cohort showed a substantial allergic symptom burden, including wheezing (45.0%), inhaler use (33.0%), and allergic rhinitis symptoms (22.0%).
Conclusions:
- Children with PNE and allergies present a distinct sleep-associated clinical phenotype.
- A significant allergic symptom burden exists in children with PNE, suggesting a link between allergy and enuresis.
- Pediatricians should inquire about PNE in allergic children and consider allergy evaluations for PNE patients.
Objective:
To determine the prevalence of primary nocturnal enuresis (PNE) in children with allergic disease, characterize the allergic symptom burden in children with PNE, and identify clinical phenotype differences between allergic and nonallergic enuretic children.
Methods:
300 children aged 5-18 years were enrolled in three groups: a specialist-confirmed allergic disease cohort (Group 1, n = 100), a nephrologist-confirmed PNE cohort (Group 2, n = 100), and a general pediatric comparison group (Group 3, n = 100). Clinical phenotype was systematically compared between allergic enuretic children and enuretic children from the comparison group. Allergic Rhinitis and its Impact on Asthma (ARIA) classification severity classification was applied in children with allergic rhinitis as a pre-specified exploratory analysis.
Results:
PNE prevalence was 1.7-fold higher in allergic children than in the comparison group (27.0% vs 16.0%; OR: 1.94, 95% CI 0.97-3.88, p = 0.060). Allergic enuretic children showed a phenotypically distinct profile: shorter enuresis duration (2.0 vs 3.0 years, p = 0.028), higher nocturnal sleep disturbance (36.0% vs. 6.7%, p = 0.060), and lower rates of stress-related exacerbation (34.6% vs. 75.0%, p = 0.025) compared with enuretic children from the comparison group. ISAAC-based screening in the PNE cohort revealed a substantial allergic symptom burden: wheezing in 45.0%, inhaler use in 33.0%, and allergic rhinitis symptoms in 22.0%. An exploratory monotonic gradient in PNE prevalence was observed across ARIA severity categories (ARIA-1: 12.5%, ARIA-2: 25.0%, ARIA-3: 33.3%; p = 0.172).
Conclusions:
Allergic enuretic children display a distinct sleep-associated clinical phenotype, and a notable allergic symptom burden is present in children with PNE. These findings support asking about nocturnal enuresis in allergic children and considering allergy-focused evaluation in selected PNE patients in general pediatric practice.
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