Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal dominant vascular disorder characterized by mucocutaneous telangiectases and visceral vascular malformations, leading to recurrent bleeding, iron-deficiency anemia, and organ complications. Pulmonary, cerebral, and hepatic involvement are major determinants of morbidity and mortality. Management has traditionally relied on local and interventional approaches, which are largely palliative and do not address underlying disease mechanisms. New insights in HHT pathophysiology, particularly in the dysregulated BMP9-BMP10/ENG/ALK1 pathway, which is fundamental to the angiogenesis process, have enabled the development of targeted systemic therapies. Although no systemic drug is specifically approved for HHT, antifibrinolytics, anti-angiogenic agents, mTOR and AKT inhibitors, and immunomodulatory drugs have shown variable efficacy in selected patients. This review summarizes current evidence on systemic therapies and ongoing clinical trials, highlighting their potential to complement existing strategies and move toward disease-modifying approaches.

In the article "House Dust Mite Sublingual Immunotherapy for Allergic Rhinoconjunctivitis: Comprehensive Review and Meta-Analytical Evidence" [Int Arch Allergy Immunol. 2026; https://doi.org/10.1159/000551015] by Alqutub et al., Table 1 was published with an error.Table 1.Summary of included studiesStudy IDStudy designCountryTotal participantsIntervention/comparatorsFollow-up, monthsInclusion criteriaConclusionBergmann 2014 [26]RCT7 European countries466HDM SLIT tablets (Stallergenes) 300IR, 500IR, or placebo12Patients (18-50 y) with HDM AR (≥1 y); controlled asthma allowed. The patient must have a positive HDM SPT and sIgE test results. The patient must have baseline symptoms12 months of 300 IR and 500 IR HDM SLIT tablets were efficacious and well tolerated. Efficacy was maintained during the treatment-free follow-up yearGuo 2017 [43]RCTChina96SLIT with a mixture of Der p and Der f extract (Pangramin SLIT; ALK-Abello) or placebo12Patients (5-55 y) with HDM AR (≥1 y) and +/-mild intermittent asthma had positive SPT and/or sIgE responses to HDMSLIT with mixed HDM extract significantly relieved AR symptoms reduced the need for antiallergic drugs compared to placebo, and was well toleratedRoux 2016 [59]RCTCanada266Sublingual tablets of HDM allergen extracts (STG320, Stallergenes) 500IR, 300IR, 100IR, or placebo6Patients (18-55 y) with uncontrolled HDM AR (≥1 y). The patients tested positive for HDM SPT and sIgE. Required baseline allergen challenge symptomsDose-dependent effect of sublingual HDM immunotherapy demonstrated in EEC. 300IR and 500IR doses are to be further evaluated. Well tolerated, AEs were mostly local and mildHoshino 2020 [44]RCTJapan111SQ-HDM SLIT tablet (Torii/ALK-Abello) plus pharmacotherapy or pharmacotherapy alone11Patients (20-65 y) with HDM AR. Positive NPT & sIgE to HDMHigh serum periostin levels at enrollment predict the clinical response (RQLQ improvement) to SQ-HDM SLIT. Serum periostin appears to be a useful biomarkerBozek 2013 [29]RCTPoland32Sublingual allergen-specific immunotherapy (SLIT) with HDM allergens (Staloral 300R, Stallergenes) or placebo36Patients (60-75 y) with HDM AR. Positive SPT, sIgE, and NPT to HDMSLIT for HDM generated significant clinical improvement (nasal symptoms, medication use) in elderly patients compared to placebo, particularly during the heating season. Well toleratedBush 2011 [32]RCTUSA (Madison, WI)21High-dose (4200 AU/d; ∼70 µg Der f 1/d) or low-dose (60 AU/d; ∼1 µg Der f 1/d) Der f SLIT vaccine (Greer Laboratories), or placebo12-18Patients (18-50 y) with Der f AR, +/- mild intermittent asthma. Positive sIgE to Der fHigh-dose Der f SLIT was generally tolerable, increased serum Der f-specific IgG4, and improved bronchial threshold to allergen. Larger US trials are warrantedLin 2015 [47]RCTChina121SLIT with Der.f drops or pharmacotherapy (oral antihistamines)48Patients (4-69 y) with moderate-to-severe Der f AR (≥1.5 y). Positive SPT & sIgEThe 3-year SLIT course was more efficacious than 1-year or 2-year courses. Patients achieved 1-year long-term clinical benefits from HDM SLITTonnel 2004 [62]RCTFrance32SLIT with Der p and Der f 50/50 allergen extract (Stallergenes) tablets (100 IR) or placebo24Patients (7-45 y) with chronic rhinitis +/- moderate asthma. HDM sensitized (SPT & RAST). Required baseline symptomsSLIT tablets showed superiority over placebo for rhinitis scores (total, blocked nose, itching) after 1 and 2 years. Low medication use in all. No serious AEsWang 2013 [63]RCTChina120SLIT with Der p and Der f extract (Zhejiang Wolwo Bio-Pharmaceutical)6Patients (4-60 y) with moderate-to-severe persistent AR +/- asthma. Positive HDM SPT & sIgESLIT with mixed HDM extract is effective and safe for HDM-induced AR. Onset of action as early as 14 weeksNolte 2016 [14]RCTUSA, Canada1,482Daily SQ HDM SLIT-tablet (12 SQ-HDM; Merck/ALK) or placebo for approx. 52 weeks12Patients (≥12 y) with HDM AR/C +/- controlled asthma. Positive HDM SPT & sIgE. Required baseline symptoms12 SQ-HDM SLIT-tablet was well tolerated and improved HDM rhinitis symptoms in North American adolescents and adults. TCRS improved 17% vs. placeboOkamoto 2016 [52]RCTJapan927HDM SLIT tablets (Shionogi/Stallergenes) 300 IR, 500 IR, or placebo12Patients (12-64 y) with HDM AR +/- intermittent asthma. Positive sIgE & NPT. Required baseline symptomsOne-year treatment with 300 IR and 500 IR HDM tablets was effective and safe for AR. The recommended therapeutic dose is 300 IROkubo 2016 [53]RCTJapan946SQ HDM SLIT-tablet (TO-203, Torii/ALK/Merck) 10,000 JAU or 20,000 JAU, or placebo12Patients (12-64 y) with moderate-to-severe HDM AR. Positive sIgE & NPTSQ HDM SLIT-tablet (both doses) confirmed efficacy and a favorable safety profile in Japanese patients with moderate to severe HDM AR. TCRS reduced from week 12Passalacqua 2006 [54]RCTItaly (multicenter)56SLIT with monomeric carbamylated allergoid of HDM (Lais; Lofarma S.p.A.) tablets (1000 AU biweekly) or placebo24Patients (18-50 y) with mild persistent AR +/- mild intermittent asthma. Positive HDM SPT & RASTSLIT with carbamylated allergoid was clinically effective (symptoms, nasal obstruction, drug intake in year 1; QoL item "change in health status") and safe in mite-induced mild diseaseMosbech 2015 [50]RCTEurope (multinational)241SQ HDM SLIT-tablet (1, 3, or 6 SQ-HDM; ALK) or placebo12Patients (≥14 y) with HDM AR & mild-to-moderate HDM asthma. Positive HDM SPT & sIgEEfficacy in mild to severe AR of 6 SQ-HDM vs. placebo was demonstrated by statistically significant improvements in TCRS and RQLQ scores in subjects with AR present at baseline. Well toleratedDidier 2016 [37]RCTFrance, Spain219SLITone ULTRA® HDM mix (50% DP/50% DF) at 50, 150, or 300 SRU.6Patients (≥18 y) with moderate-to-severe persistent HDM AR +/- asthma. Positive SPT & sIgE. Required baseline symptomsDose-response for immunological markers (IgE-blocking factor, IgG4) and safety. 300 SRU showed a better immunological response and was considered the optimal maintenance dose. AEs increased with dose, mostly mild to moderateMacedo 2025 [48]RCTBrazil65SLIT with liquid drops combining extracts of Der p (1 μg Der p 1/day) and Blo t (753 UBE Blo t/day) or placebo12Patients (12-60 y) with moderate/severe persistent AR (≥ 2 y). Sensitized to Der p & B. tropicalis (SPT or sIgE)After 1 year, SLIT drops significantly reduced antihistamine use vs. placebo with a good safety profile. No significant changes in serum total IgE, sIgE, or IgG4 for either allergen vs. placeboHüser 2016 [67]RCTGermany12712-week treatment with sublingual monomeric allergoid tablets (carbamylated, Der p and f; Lofarma S.p.A.) at 300, 1,000, 2000, or 3000 UA/day, or placebo3Patients (18-75 y) with HDM allergic rhinoconjunctivitis (≥2 y). Positive sIgE, SPT, & CPT12-week daily treatment with 2000 UA/day monomeric allergoid SLIT tablets is well tolerated and reduces CPT reaction in HDM-allergic patients. (The primary endpoint of mean allergic severity decrease was not statistically significant)Demoly 2016 [35]RCT12 European countries992SQ HDM SLIT-tablet (ALK) at 6 SQ-HDM or 12 SQ-HDM, or placebo12Patients (18-65y) with moderate-to-severe HDM AR despite pharmacotherapyBoth 6 SQ-HDM and 12 SQ-HDM SLIT tablets confirmed efficacy (reduced TCRS, symptoms, improved QoL) and favorable safety profile in adults with HDM-induced AR. The treatment effect was observed starting from 14 weeks onwardDemoly 2020 [36]RCTEurope, USA, Canada, Israel, Russia1,476300 IR HDM SLIT tablet (Der p: Der f 1:1 extract; Stallergenes Greer) or placebo12Patients (≥12y) with moderate-to-severe HDM ARThe 300 IR sublingual HDM tablet is an effective, safe treatment for HDM-induced allergic rhinitis in adults and adolescents, with clinically meaningful benefits and good tolerabilityPotter 2015 [57]RCTSouth Africa60HDM SLIT (Staloral 300 IR/mL, Der p; Stallergenes) or placebo24Patients (18-60 y) with persistent Der p rhinitis. Positive SPTA good clinical response (≥60% improvement in symptoms and QoL) to 2 years of HDM SLIT is associated with significant decreases in IL-5, IL-13, and IL-4 relative to IFN-γ. Both SLIT and placebo groups showed clinical improvementNolte 2015 [51]RCTAustria (Vienna Challenge Chamber)124HDM SLIT tablet (MK-8237; Merck/ALK-Abello) at 12 DU, 6 DU, or placebo6Patients with HDM AR/C +/- asthma (for EEC study)MK-8237 (12 DU) HDM SLIT-tablet reduced nasal and ocular symptoms in an EEC, exceeding WAO clinical efficacy criteria. The onset of action for 12 DU was week 8. Dose- and time-dependent improvements were observed. Well toleratedGunawardana 2017 [42]RCTUK2312 SQ-HDM SLIT-tablet (MK-8237; Merck & Co/ALK) or placebo3Patients (18-55 y) with HDM AR. Positive SPT & sIgE. Required NAC symptom scores12 SQ-HDM SLIT-tablet significantly increased serum HDM-specific IgG4 and IgE blocking factor and significantly decreased early-phase nasal symptoms after NAC. No significant effects on mucosal cytokinesGuez 2000 [41]RCTFrance72SLIT with Der p f 50/50 allergen extract (Staloral 300 IR/mL; Stallergenes) or placebo24Patients (6-51 y) with chronic rhinitis +/- moderate asthma. HDM sensitized (SPT & RAST). Required baseline symptomsActive SLIT treatment was superior to placebo for rhinitis scores (total, blocked nose, itching) after 1 and 2 years. Low medication use. No serious AEs. Availability of a solid form (tablet) would be progressChen 2020 [34]RCTChina86Treatment group: SLIT with Der f drops (CHANLLERGEN®, WolwoBiotech) + pharmacotherapy on demand. Control group: Standard pharmacotherapy only24Patients (60-75 y) with moderate/severe persistent AR (≥2 y). Positive sIgE to HDMSLIT plus pharmacotherapy provided a greater clinical benefit (CSMS, VAS) than pharmacotherapy alone at 2 years in elderly patients (60-75 years) with HDM-induced AR. 41.9% of patients dropped out within 2 years of SLITJordakieva 2017 [45]RCTAustria77Intervention: HDM allergen challenge in a chamber. <br> Groups: Placebo SLIT, Low-dose HDM SLIT, High-dose HDM SLIT.3-16Patients (18-65 y) with HDM AR +/- mild intermittent asthma. Confirmed HDM sensitization (SPT & sIgE)Airway allergen challenge in HDM-allergic subjects leads to a significant decrease in circulating erythrocytes and an increase in neutrophils, regardless of prior SLIT. SLIT had no impact on this acute responseBozek 2021 [30]RCTPoland30SQ-HDM SLIT tablets or placebo12Patients (>18 y) with LAR to HDM & mild-to-moderate asthma. Positive NPT, negative SPTSLIT improved nasal and bronchial symptoms and reduced symptomatic treatment in patients with LAR and asthma with hyperresponsiveness to HDMsBożek 2023 [31]Prospective, observational studyPoland60SLIT (Staloral mites) or SCIT (Purethal mites) for HDM.120Patients (>60 y) with perennial AR. Monosensitized to HDMAIT (SLIT and SCIT) may be beneficial for treating seniors with HDM-allergic rhinitis. Sustained decrease in clinical symptoms relative to placebo after 7 years of follow-up. sIgG4 is constantly presentGao 2020 [40]Prospective observational studyChina135SLIT with Der f drops (Chanllergen; Zhejiang Wolwo Bio-Pharmaceutical)36Patients (4-60 y) with moderate-to-severe HDM AR. Positive sIgESix months might be a critical time point for efficacy assessment and dosage adjustment for AR patients after SLIT. In patients with low response, dosage enhancement within a specific range may enhance effectivenessSoh 2016 [60]Prospective observational studySingapore39Standardized Staloral® HDM extract (Der p, Der f, and/or B. tropicalis)24Patients with persistent AR. Positive SPT to Der p, Der f, or B. tropicalisSublingual immunotherapy with HDM extracts (including B. tropicalis) is efficacious for HDM allergic rhinitis over 2 years. Symptom and QoL scores improvedKim 2010 [46]Prospective observational studyKorea58SLIT with standardized HDM extracts (50% Der p/50% Der f; Pangramin SLIT; ALK-Abello)12Patients with AR are monosensitized to HDM. Positive SPT and/or sIgESLIT improved symptoms and medication scores in Korean patients with HDM AR. Changes in ECP and sIgE for Der f were observed. High ECP may predict effectivenessXu 2015 [65]Prospective observational studyChina50SLIT with Der f drops for >1 year. Monosensitized (n = 20) vs. Polysensitized (n = 30) groups>12Patients (4-60 y) with moderate-to-severe dust mite AR. Positive SPT & sIgENo significant difference in SLIT efficacy between dust mite monosensitized and polysensitized AR patientsBaba 2021 [12]Prospective observational studyIndia (Kashmir)244SLIT tablets (HDM-specific: Df, Dp, Blomia) vs. SLIT+PT vs. PT alone36Patients with mild-moderate persistent asthma and/or moderate-severe AR. HDM monosensitized (confirmed by SPT)SLIT demonstrated sustained clinical improvement, ICS dose/duration reduction, and prevention of desensitization in HDM-sensitized endobronchial allergies. No significant change in skin reactivity or sIgE/total IgE ratioMeng 2016 [49]Prospective observational studyChina46HDM SLIT (Der f drops; Chanllergen)12Patients with moderate-to-severe persistent AR. HDM sensitized (SPT and/or sIgE)HDM SLIT downregulated Th2-type immune responses mediated by the TSLP-OX40L signaling pathway. TNSS, INSS, and TSLP in nasal lavage decreasedTempels-Pavlica 2024 [61]Prospective observational studyNetherlands415Daily intake of 12 SQ-HDM SLIT-tablet (ACARIZAX; ALK-Abelló)12Patients (18-65 y) with HDM AR +/- asthma were prescribed an HDM SLIT-tablet (real-world evidence)HDM SLIT-tablet is a safe and well-tolerated AR treatment in Dutch daily clinical practice. AEs occur often but are mostly mild and decrease during the first year. CARAT scores improved, and medication use decreasedZhu 2021 [66]Prospective observational studyChina78SLIT (standardized Der f allergen drops; Wolwo Pharma Biotechnology)36Patients with HDM AR. Positive SPT and/or sIgESerum sST2 levels increased in HDM-induced AR, correlated with severity, and sST2 is a potential biomarker for predicting SLIT responseChan 2019 [33]Prospective case-controlled studyHong Kong120SLIT with allergen extract (SLITone Ultra HDM ALK-Abello)12Patients with HDM perennial AR. Positive sIgE or SPTSLIT was an adjunctive therapy that improved not only allergic rhinitis outcomes but also comorbid allergic conditions (asthma, allergic conjunctivitis, and atopic dermatitis). Treatment-related adverse reactions were mild and self-limitingReiber 2021 [58]Prospective observational studyGermany1,525Standardized quality (SQ) HDM SLIT-tablet (ACARIZAX, ALK)12Patients with HDM AR +/- asthma were prescribed SQ HDM SLIT tablet in routine practice (real-world evidence)SQ HDM SLIT-tablet was effective and well-tolerated in real-life clinical practice. ADRs consistent with RCT data. Asthma control improvedPei 2025 [55]Retrospective observational studyChina74SLIT with standard Der f drops (Zhejiang Wolwo Bio-Pharmaceutical)12Patients (4-60 y) with moderate-to-severe AR with epistaxis. Positive HDM SPTSLIT with Der f drops was effective and safe for AR patients with epistaxis, improving rhinitis symptoms while relieving epistaxis. BS correlated with CSMS and VASWang 2024 [68]Retrospective observational studyChina258Individualized dynamic ascending high-dose HDM-SLIT drops or regular-dose HDM-SLIT drops24Patients (4-57 y) with moderate-to-severe HDM AR. Positive SPTA 2-year dynamic dose-ascending regimen for HDM-SLIT offers superior efficacy for AR patients compared to a regular dose while maintaining safetyFritzsching 2022 [39]Retrospective observational studyGermany8,570Allergen immunotherapy (AIT)-various forms, including SLIT tablets for HDM, grass, tree, cedar, and ragweed108Patients with a confirmed diagnosis of AR +/- asthma receiving AIT (retrospective database study)AIT demonstrated longer-term and sustained real-world effectiveness in AR and asthma, including reduced medication, exacerbations, and pneumoniaPfaar 2024 [56]Post hoc analysis of RCT (Demoly 2020)9 European countries818300 IR HDM SLIT tablets (Stallergenes Greer) or a placebo daily for 12 months (original trial)12Patients with moderate-to-severe HDM-AR Positive HDM IgE & SPT. Required baseline symptomsThis sub-analysis confirmed the 300 IR HDM SLIT tablet is an effective and safe treatment for European adults/adolescents with HDM-AR, with clinically meaningful benefits, even better than in the overall trial populationWorm 2024 [64]Pooled analysis of 8 RCTsMultinational3,171300IR HDM-SLIT tablet (Actair®/Orylmyte®/Aitmyte®) vs. placeboUp to 12Patients (5-65 y) with HDM AR (≥1 y) +/- controlled asthma. Confirmed HDM sensitization (pooled analysis)The 300IR HDM-SLIT tablet has a favorable safety profile, confirmed by both RCTs and real-world experience. It is well-tolerated in adults, adolescents, and children, regardless of asthma statusBernstein 2018 [27]Pooled analysis of 5 RCTsUSA, Canada, Europe2,923SQ HDM SLIT-tablet (12 SQ-HDM; ALK-Abelló/Merck)Up to 13Patients (often ≥12 or ≥18 y) with HDM AR/C (≥1 y) +/- asthma Positive HDM SPT and/or sIgE. Required baseline symptoms (pooled analysis)12 SQ-HDM SLIT-tablet consistently improved symptoms and was well tolerated in relevant subgroups. Local application site reactions were typically mild-to-moderate and transientEmminger 2017 [38]Pooled analysis of 2 RCTsEurope1,215SQ HDM SLIT-tablet (12 SQ-HDM) vs. placebo12-19Patients with HDM respiratory allergy (rhinitis and/or asthma) (pooled analysis)The SQ HDM SLIT tablet is well tolerated. The safety profile was comparable for subjects with HDM respiratory allergic disease, irrespective of their asthma status or control levelBlaiss 2024 [28]Pooled analysis of 11 RCTEurope, North America (original trials)2,221SQ SLIT tablets for grass, tree, ragweed, and HDM (ALK)VariablePatients with AR/C (from original trials) (pooled analysis)Consistent and statistically significant improvements in overall RQLQ scores across all 4 SQ SLIT tablets (including HDM) vs. placeboAbbreviations: AE (Adverse Event), AIT (Allergen Immunotherapy), AR (Allergic Rhinitis), AR/C (Allergic Rhinitis and/or Conjunctivitis), AU/d (Allergen Units per day), Blo t (Blomia tropicalis), BS (baseline symptom scores), CARAT (Control of Allergic Rhinitis and Asthma Test), CPT (Conjunctival Provocation Test), CSMS (Combined Symptom and Medication Score), Der f (Dermatophagoides farinae), Der p (Dermatophagoides pteronyssinus), DU (Developmental Unit), EEC (Environmental Exposure Chamber), HDM (House Dust Mite), ICS (Inhaled Corticosteroid), IgE (Immunoglobulin E), IgG4 (Immunoglobulin G4), INSS (Individual Nasal Symptom Score), IR (Index of Reactivity), JAU (Japanese Allergy Unit), LAR (Local Allergic Rhinitis), NAC (Nasal Allergen Challenge), NPT (Nasal Provocation Test), OX40L (OX40 Ligand), QoL (Quality of Life), RAST (Radioallergosorbent Test), RCT (Randomized Controlled Trial), RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire), SCIT (Subcutaneous Immunotherapy), sIgE (specific Immunoglobulin E), sIgG4 (specific Immunoglobulin G4), SLIT (Sublingual Immunotherapy), SPT (Skin Prick Test), SQ (Standardized Quality), SRU (Standard Reactivity Unit), sST2 (soluble Suppression of Tumorigenicity 2), TCRS (Total Combined Rhinitis Score), TNSS (Total Nasal Symptom Score), TSLP (Thymic Stromal Lymphopoietin), UA/day (Units of Allergoid per day), VAS (Visual Analog Scale), WAO (World Allergy Organization), y (year).The corrected Table 1 is shown on the following pages.

Primary cutaneous aspergillosis (PCA) is an uncommon mycosis resulting from direct inoculation of Aspergillus into the skin. We report the case of a 33-year-old woman with acute myeloid leukemia (AML) who developed a rapidly progressive paranasal erythematous lesion after induction chemotherapy, febrile neutropenia, and anterior nasal packing for epistaxis. Despite broad-spectrum antibiotics, the lesion evolved into a violaceous necrotic plaque with facial cellulitis and nasal obstruction. Direct microscopy showed hyaline septate hyphae with acute-angle branching and culture identified Aspergillus flavus. Histopathology confirmed tissue invasion by fungal elements. The patient improved after voriconazole therapy following neutrophil recovery, with complete clinical healing. This case shows that early mycological diagnosis and rapid antifungal therapy are essential in immunocompromised patients with necrotic skin lesions.

A nine-year-old Trakehner mare was presented three days after an episode of severe epistaxis, showing intermittent foul-smelling nasal discharge with feed material and rostral displacement of the upper incisor teeth. Radiographic and computed tomography examinations revealed a complete comminuted fracture of the right side and an oblique complete fracture of the left side nasal processes of the incisive bone and maxillary bone, as well as open fractures of the nasal septum and palatine bone with displacement of the incisor part rostrally and development of an oronasal communication. The fracture was treated by osteosynthesis using a locking compression plate on the left side of the incisive bone and cerclage wire connecting incisors and premolars of the upper jaw on both sides. Pressure on the fracture line during mastication was reduced by adjusting incisor length. Soft tissues of the hard palate were closed with sutures and managed with daily flushing of the oronasal communication. The mare showed good clinical condition during the whole treatment period. 9-week follow-up examination showed good upper jaw stability and cosmesis. CT-examination confirmed proper bone alignment and complete soft tissue healing.

Patients with hereditary hemorrhagic telangiectasia (HHT) experience recurrent epistaxis. Doxycycline has been proposed as a possible treatment, although its efficacy remains controversial. Whether the most common genotypes (activin receptor-like kinase 1, endoglin, and SMAD4) contribute to a differential response has not been investigated. In this study, we evaluate the effectiveness of doxycycline among the different HHT genotypes. A retrospective cohort study was conducted at the University of Florida's Hereditary Hemorrhagic Telangiectasia Center. Forty-one adult patients (aged ≥18 years) with HHT, diagnosed by Curacao criteria and genetic testing, were classified as responders and nonresponders based on the minimal clinically important change between pre- and posttreatment epistaxis severity scores (ESS). Hemoglobin and hematocrit values were also collected to assess treatment response. Overall, the cohort was 61% female and 90.2% White, with a mean age of 58.1 years; 26 responders had a decrease (P < .0001) in ESS from a baseline median of 4.6 (interquartile range [IQR], 3.3) to posttreatment ESS of 2.4 (IQR, 1.9). The median baseline ESS for the total cohort was 4.4 (IQR, 3.3), and after a mean follow-up of 4.1 months, it significantly (P < .0001) decreased to an ESS of 3.3 (IQR, 3.2). The mean hemoglobin and hematocrit values did not exhibit significant changes. The relationship between genotype and doxycycline response was not statistically significant. Patients with HHT treated with doxycycline showed an overall reduction in epistaxis severity, which did not appear to be associated with genotype. Doxycycline may be a safe, effective, and accessible treatment option for epistaxis in HHT.

A man in his 20s presented with progressive fatigue and melena, with a history of recurrent epistaxis since adolescence and a positive family history. Evaluation revealed severe iron-deficiency anaemia (haemoglobin 27 g/L) with persistently positive faecal occult blood. Upper gastrointestinal endoscopy demonstrated multiple bleeding telangiectasias in the stomach and duodenum. Cross-sectional imaging of abdomen, thorax and brain identified multisystem arteriovenous malformations involving the liver, lung and brain. Despite repeated argon plasma coagulation and thalidomide therapy, bleeding persisted with ongoing transfusion dependence. Treatment with intravenous bevacizumab and subcutaneous octreotide stabilised haemoglobin and resolved occult gastrointestinal bleeding. A clinical diagnosis of hereditary haemorrhagic telangiectasia was established using Curaçao criteria despite negative genetic testing. This case highlights the importance of recognising hereditary haemorrhagic telangiectasia in unexplained severe anaemia and supports the role of anti-angiogenic therapy in refractory gastrointestinal bleeding.

We describe a case of sinonasal glomangiopericytoma (GPC), a rare perivascular tumour accounting for less than 0.5% of sinonasal neoplasms, presenting with refractory unilateral epistaxis. An anticoagulated male in his 60s required admission, nasal packing and unilateral left internal maxillary artery embolisation to achieve haemostasis.Following stabilisation, nasoendoscopy identified a vascular polypoid lesion arising high in the left nasal cavity near the olfactory cleft. MRI demonstrated a contrast-enhancing mass abutting the cribriform plate without orbital or skull-base invasion, which had not been recognised on prior imaging. Endoscopic biopsy confirmed GPC, followed by endoscopic resection at a tertiary skull-base centre.Postoperative recovery was uncomplicated, with early resolution of epistaxis and safe recommencement of anticoagulation. However, the tumour was transected at the surgical margin, indicating incomplete or margin-uncertain excision and requiring close surveillance for residual or recurrent disease. This case highlights a rare cause of refractory unilateral epistaxis and illustrates the importance of diagnostic vigilance, multidisciplinary management and the potential role of embolisation in selected high-risk patients.

BackgroundMedical treatment has been the mainstay of chronic rhinitis management. Meanwhile, innovative minimally invasive nasal surgery has shown promising results. The therapeutic outcomes of these surgical interventions compared with medical treatment in chronic rhinitis have not been discussed previously.ObjectiveThis study aimed to evaluate the efficacy of radiofrequency ablation of the inferior turbinate of the intraturbinate segment of the posterior nasal nerve (RAPN) in comparison with intranasal corticosteroid spray (INCS) plus oral antihistamines for the treatment of chronic rhinitis.MethodsA retrospective cohort study was conducted on patients with chronic rhinitis who had an inadequate response to medication. Inclusion criteria included a 24-h Reflective Total Nasal Symptom Score (rTNSS) ≥4 and a rhinorrhea score ≥1. Patients with prior nasal surgeries, caudal septal deviation, or acute/chronic rhinosinusitis were excluded. The primary endpoint was the change in 24-h rTNSS and Nasal Obstruction Symptom Evaluation (NOSE) scores at the 3-month follow-up.ResultsA total of 64 patients were included: 44 received RAPN, and 20 received INCS. Baseline rTNSS was 7.3 ± 2.1 for RAPN and 6.9 ± 2.3 for INCS (p = .497). Both groups showed significant improvement in rTNSS and NOSE scores at 1 and 3 months (p < .001). However, the RAPN group demonstrated significantly greater improvement than the INCS group at 1 to 3 months of follow-up (p = .001). Subscore analysis revealed that rhinorrhea (at 1 and 3 months) and sneezing (at 1 month) did not differ significantly between groups. One case of postoperative anterior epistaxis was noted in the RAPN group.ConclusionsBoth INCS and RAPN are highly effective in alleviating chronic rhinitis symptoms. Although RAPN does not establish definitive superiority over medical therapy across all neurogenic domains, it provides comparable, sustained symptom control with the distinct advantage of drug-free maintenance, offering a valuable therapeutic alternative.