Histamine-induced itching may respond to doxepin in a low dosage. Urticaria and pruritus that are related to Hodgkin's disease may be relieved by histamine H 2 receptor-blocking drugs. Nocturnal enuresis often has multifactorial causes. Nocturnal enuresis may also result from low bladder capacity, detrusor instability or poor sleep arousal, or it may be associated with other developmental, psychologic or physical conditions, including the use of medications. Although a thorough history is essential, physical and laboratory examinations rarely provide additional diagnostic information.
Treatment is recommended for children older than seven years with persistent nocturnal enuresis.
Bed-wetting alarms, when used properly and persistently, provide success rates of over 70 percent. Families of children who use the alarms may require significant support. If alarms are unsuccessful after eight to 12 weeks, desmopressin may be successful. This synthetic analog of ADH is taken as a nasal spray, one puff in each nostril at bedtime. Desmopressin also works synergistically with alarms and is useful on occasions when the child has to sleep away from home and the alarm is impractical.