{"doi":"10.1002/alr.70069","title":"Association of In‐Office Sclerotherapy With Epistaxis Severity and Quality‐of‐Life in Hereditary Hemorrhagic Telangiectasia","abstract":"Epistaxis affects more than 90% of hereditary hemorrhagic telangiectasia (HHT) patients, but there is no standard-of-care treatment [1]. Sclerotherapy involves injecting a sclerosing agent to obliterate vascular lesions. It has been associated with improved epistaxis severity and general health-related quality of life (QoL) [2, 3]. Doxycycline has also been associated with reduced epistaxis severity and is often used empirically due to its favorable safety profile [4]. Epistaxis affects more than 90% of hereditary hemorrhagic telangiectasia (HHT) patients, but there is no standard-of-care treatment [1]. Sclerotherapy involves injecting a sclerosing agent to obliterate vascular lesions. It has been associated with improved epistaxis severity and general health-related quality of life (QoL) [2, 3]. Doxycycline has also been associated with reduced epistaxis severity and is often used empirically due to its favorable safety profile [4]. This prospective case series investigates the association of sclerotherapy with HHT-related epistaxis severity and QoL across multiple validated outcome measures, assesses how concurrent initiation of doxycycline may modulate these effects, and depicts nasal mucosal changes post-sclerotherapy. Consecutive HHT patients with an average Nasal Outcome Score for Epistaxis in HHT (NOSE HHT) [5] greater than one who presented between 2022 and 2024 for sclerotherapy with or without initiation of doxycycline were prospectively enrolled. Doxycycline was offered to all patients who had not previously tried it and was primarily initiated based on patient's desire for further epistaxis control. Patients receiving additional treatments during the study period were withdrawn from the study but could be re-consented and re-enrolled. Patients already taking medications, including doxycycline, and patients who stopped taking doxycycline before enrollment were placed in the sclerotherapy-only group, as sclerotherapy was the only change to their regimen. The primary outcome measure was change in NOSE HHT 2 weeks and 3 months post-sclerotherapy, which ranges from 0 (less severe impact on QoL) to 4 (more severe impact) and has a minimal clinically important difference (MCID) of 0.46 [5]. The NOSE HHT was chosen since it focuses on the physical problems, functional limitations, and emotional consequences of HHT-related epistaxis specifically. Secondary outcome measures included change in Epistaxis Severity Score (ESS) [6], 3 months post-sclerotherapy, and Clinical Global Impression-Severity (CGI-S) score and Clinical Global Impression–Improvement (CGI-I) score, 2-weeks and 3- months post-sclerotherapy. Acute and self-reported complications were recorded. Repeat endoscopic imaging was offered to patients who lived nearby. Descriptive statistics were calculated. Median difference between baseline, 2-week, and 3-month scores and 95% CI were estimated. Mann–Whitney U and chi-square tests were used to explore differences between the doxycycline and no doxycycline groups. Analysis was conducted using IBM-SPSS version 29.0.2.0. A total of 43 patients were enrolled. Nine (21%) were enrolled multiple times. Only data from the most recent enrollment were analyzed, regardless of response from prior procedures. Of the 43 patients, 22 (51%) were female and 41 (95%) were white. Median NOSE HHT scores were 1.8 at baseline, 1.0 at 2 weeks, and 1.1 at 3 months (Table 1). Median change from baseline to 2 weeks was −0.59 (95% CI −0.76, −0.45; p < 0.001; n = 39) and −0.53 (95% CI −0.69, −0.38; p < 0.001; n = 40) from baseline to 3 months, suggesting a clinically meaningful change. A total of 56% (22/39) of patients experienced a clinically meaningful improvement 2 weeks post-sclerotherapy versus 58% (23/40) 3 months post-sclerotherapy (percent difference = 1.1%; 95% CI −20.7%, 22.9%; p = 0.922). Change from baseline, median (95% CI) Median ESS was 5.7 at baseline and 3.2 at 3 months (median change: −1.9 [95% CI −2.7, −1.0; p = 0.001]). The","journal":"International Forum of Allergy & Rhinology","year":2025,"id":583028,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":0,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.955,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2025-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1494945,"name":"Amy E. Ensing","orcid":"0009-0001-0580-1857","position":1,"is_corresponding":false},{"id":1148289,"name":"Firas Hentati","orcid":"0000-0003-3471-3933","position":2,"is_corresponding":false},{"id":495369,"name":"Andrew M. Peterson","orcid":"0000-0001-9965-1572","position":3,"is_corresponding":false},{"id":231284,"name":"Dorina Kallogjeri","orcid":"0000-0001-5365-0988","position":4,"is_corresponding":false},{"id":231285,"name":"Jay F. Piccirillo","orcid":"0000-0002-4062-1747","position":5,"is_corresponding":false},{"id":1304088,"name":"Jenny Ji","orcid":"0000-0003-0978-828X","position":0,"is_corresponding":true}],"reference_count":8,"raw_metadata":null,"created_at":"2026-07-19T02:58:59.653747Z","pmid":"41277387","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}