Lifestyle and Dietary Influences on Nosebleed Severity in Hereditary Hemorrhagic Telangiectasia

Abstract

ObjectiveTo identify factors influencing the severity of epistaxis in hereditary haemorrhagic telangiectasia. Study designParticipants with and without hereditary haemorrhagic telangiectasia were recruited from a specialist UK service, and online following advertisement by the HHT Foundation International. Both groups were asked to complete a non-biased questionnaire. MethodsThe reported effects of specific treatments or lifestyle factors on epistaxis were assigned positive values if beneficial, negative values if detrimental, zero if "no difference," and summed to enable statistical analysis. ResultsEpistaxis affected 649/666 (97%) participants with hereditary haemorrhagic telangiectasia and was significantly more frequent than in control participants. Specialist invasive treatments were reported as beneficial, laser therapy more frequently than cauterisation. Medical treatments commonly used for HHT epistaxis (female hormones, anti-oestrogens, 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 4 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, gingko biloba and vitamin E15) or in omega-3 acids (oily fish, salmon). ConclusionThis study supports existing treatments and suggests lifestyle and dietary manoeuvres that may also improve nosebleeds in hereditary haemorrhagic telangiectasia.

Dietary supplement use and nosebleeds in hereditary haemorrhagic telangiectasia ‒ an observational study

“…However, in recent studies by our group, HHT patients reported that nosebleeds could be precipitated by certain food groups (13,14). Spontaneously volunteered precipitant foods included red wine, spices, chocolate, coffee, berries, oily fish, and other food items that contain high levels of naturally occurring salicylates and other anti-platelet agents (13). We hypothesised that for some people, suggesting dietary changes may also detrimentally impact on their quality of life, and therefore examined nosebleed relationships with dietary supplements that may be more readily modified.…”

“…HHT nosebleeds are highly variable, and generally difficult to predict. However, in recent studies by our group, HHT patients reported that nosebleeds could be precipitated by certain food groups (13,14). Spontaneously volunteered precipitant foods included red wine, spices, chocolate, coffee, berries, oily fish, and other food items that contain high levels of naturally occurring salicylates and other anti-platelet agents (13).…”

Hereditary Hemorrhagic Telangiectasia: A Primer for Critical Care Nurses

“…The alteration in the signaling pathways causes abnormal development of blood vessels, such as dilated venules (eg, telangiectasias) and open arteriovenous channels. 9 The current understanding is that some unknown vessel injury causes angiogenic stimulation, which results in the vessels' inability to mature correctly.…”

“…In a study of 43 patients with HHT, the results suggested that the antioxidant might decrease the severity and frequency of diurnal epistaxis, but it was most effective in men. 34 Silva et al 9 found that most treatments were temporary measures and that most therapies needed repetition. They also found that avoidance of fish oils and high-sali cylate foods (eg, alcohol, red wine, cayenne pepper, capsicum, chocolate, coffee) was associated with a decrease in epistaxis.…”

Hereditary haemorrhagic telangiectasia

“…It varies in severity and frequency but can significantly affect patients' quality of life (30)(31)(32)(33) . Certain foods, often those containing high salicylate levels, have been reported to worsen epistaxis, as have low humidity and changes in temperature (34) . Various subjective grading systems are available (35,36) , and objective classification of the pattern of lesions has also been described (37) .…”