Nocturnal enuresis in children with allergic disease: prevalence, phenotype, and ARIA severity analysis.

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.