title: Lifestyle and dietary influences on nosebleed severity in hereditary hemorrhagic telangiectasia.
abstract: OBJECTIVE
  To identify factors influencing the severity of epistaxis in hereditary hemorrhagic telangiectasia (HHT).
  
  
  METHODS
  Participants with and without HHT were recruited from a specialist service and online following advertisement by the HHT Foundation International. Both groups were asked to complete a nonbiased questionnaire.
  
  
  METHODS
  The reported effects of specific treatments or lifestyle factors on epistaxis were assigned positive values if beneficial, negative values if detrimental, or zero if "no difference" and were summed to enable statistical analysis.
  
  
  RESULTS
  Epistaxis affected 649 of 666 (97%) participants with HHT and was significantly more frequent than in control participants. Specialist invasive treatments were reported as beneficial, laser therapy more frequently than cauterization. Medical treatments commonly used for HHT epistaxis (female hormones, antiestrogens, tranexamic acid, aminocaproic acid, nasal creams, and bevacizumab) also had significantly positive (beneficial) scores. Lifestyle and dietary factors were generally detrimental, but room humidification, nasal lubrication, and saline treatments were all reported as beneficial (95% confidence intervals greater than zero). Multiple food items were volunteered as being detrimental to epistaxis. The most frequently reported items were alcohol (n = 45; 6.8% of participants) and spices (n = 26, 3.9% of participants). Remaining foods reported to exacerbate epistaxis were also found to be high in salicylates (including red wine, spices, chocolate, coffee, and certain fruits), natural antiplatelet activity (garlic, ginger, ginseng, ginkgo biloba, and vitamin E15), or omega-3 acids (oily fish, salmon).
  
  
  CONCLUSIONS
  This study supports existing treatments and suggests lifestyle and dietary maneuvers that may also improve nosebleeds in HHT.
  
  
  METHODS
  2c.
authors: HHTIC London, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.
authors: B Maneesha
authors: BM
authors: Silva
authors: Anna E
authors: AE
authors: Hosman
authors: Hannah L
authors: HL
authors: Devlin
authors: Claire L
authors: CL
authors: Shovlin
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004032:Diet; D004844:Epistaxis / Q000209:etiology / Q000517:prevention & control* / Q000523:psychology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D013683:Telangiectasia, Hereditary Hemorrhagic / Q000150:complications*; D016896:Treatment Outcome; D055815:Young Adult