In this allergic rhinitis acupuncture research, investigators attempted to assess the efficacy and safety of acupuncture for allergic rhinitis (AR) and to test the robustness of the estimated effects. They followed the Cochrane methodology standard and included randomized controlled trials (RCTs) comparing acupuncture with other therapies for AR. Furthermore, they conducted a sequential trial analysis to test the robustness of pooled results. In all, they included thirty trials with 4413 participants.
Overview
Acupuncture improved the nasal symptoms on Total Nasal Symptom Score (TNSS) and quality of life measured by the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) in adults with AR, compared to acupuncture with no intervention. Acupuncture also proved more effective than sham (fake) acupuncture for nasal symptoms and quality of life.
Results were comparable when evaluating acupuncture versus Western medications (cetirizine or loratadine), although acupuncture had significantly fewer adverse effects. Researchers concluded that, based on the data, acupuncture had an advantage over no intervention and sham acupuncture in improving nasal symptoms and quality of life for adults with AR. In addition, the effect of acupuncture and cetirizine or loratadine for AR was similar.
What is Allergic Rhinitis (AR)?
Allergic rhinitis (AR) is a nasal disorder resulting from an immunological reaction to allergen exposure. As of 2022, AR is estimated to affect nearly 1.4 billion people globally and continues to be on the rise. Although AR is not life-threatening, it underlies many complications, such as bronchial asthma, sinusitis, nasal polyps, otitis media, and allergic conjunctivitis, affecting the quality of life and work productivity.
The current mainstream treatment of AR primarily includes Western medications such as topical steroids, oral antihistamines, and immunotherapy. These drugs are recommended by the National Guideline Clearinghouse (NGC) as they can rapidly relieve nasal symptoms. But unfortunately, they include unpleasant side effects, including nose bleeds, dry eyes, and fatigue, among others. Moreover, some patients prefer non-pharmacologic options.
Acupuncture and Allergic Rhinitis
Acupuncture is a component of Traditional Chinese Medicine (TCM). It utilizes acupoints to stimulate energy flow (called Qi) through the body. Approximately 18% of patients with AR seek acupuncture therapy. Research demonstrates that acupuncture modulates biomarkers to relieve the symptoms of AR. In 2015, the American clinical practice guidelines on allergic rhinitis listed acupuncture as an appropriate therapy for AR.
Methods
Investigators performed this allergic rhinitis acupuncture research in accordance with the Cochrane Handbook for Systematic Reviews of Interventions. Studies had to include the following criteria:
- They were randomized controlled trials (RCTs)
- Participants had a diagnosis of AR
- Intervention included manual acupuncture, electric acupuncture (EA), or warm needling
Comparisons were described as follows:
- Acupuncture versus no intervention
- Acupuncture versus sham acupuncture
- Acupuncture versus specific western medication
- Acupuncture combined with western medication versus western medication alone
Primary outcomes included:
- Achieving clinical response in nasal symptoms: defined as the decreased rate of Total Nasal Symptom Score by at least 25%
any change in nasal symptoms score - Quality of life, measured by any validated scales, such as the Rhinoconjunctivitis Quality of Life Questionnaire
Secondary outcomes included:
- Adverse events
- Immune responses such as the changes in serum levels of IgE, interferon-γ, and interleukin.
Characteristics of studies
The 30 trials had 4413 participants in multiple countries, including Australia, China, Germany, South Korea, and Sweden. The sample size of studies ranged from 24 to 981. The treatment durations ranged from 2 to 12 weeks. Acupuncture techniques included needle acupuncture, warm needling, and electroacupuncture. Furthermore, the controls had no treatments (waiting to receive other interventions at the end of the trial), sham acupuncture, cetirizine, loratadine, terfenadine, and desloratadine.
Acupuncture versus no intervention
Three allergic rhinitis acupuncture research studies compared acupuncture with no intervention control. Choi 2012 found that acupuncture relieved the severity of total nasal symptoms score on the TNSS scale compared to no intervention control. Data pooled from three studies also showed that acupuncture improved the life quality of patients, measured by RQLQ. Subgroup analyses showed this beneficial effect of acupuncture was observed in all time points of outcome measurement (4 weeks, 8 weeks, and 3 months) and different countries (Germany, China, Korea, and Australia).
Acupuncture versus sham acupuncture
Four studies compared acupuncture with sham acupuncture. Sham acupuncture refers to a shallow needling technique in which practitioners insert needles 10 to 15 mm away from the actual acupuncture points. The post-intervention nasal symptoms score was lower in the acupuncture group than in the sham acupuncture group. Subgroup analysis showed that acupuncture’s beneficial effect remained after eight weeks of intervention. Both studies showed that the real acupuncture group had significantly improved nasal symptoms compared to the sham acupuncture group. Evidence from three trials demonstrated that the acupuncture group had significantly improved life quality (RQLQ) compared to the sham acupuncture group.
Acupuncture versus western medication
Seventeen allergic rhinitis acupuncture research trials compared acupuncture with western medication. The western medication used in trials included cetirizine, loratadine, terfenadine, Tranilast capsules, and desloratadine. Six trials compared acupuncture with cetirizine. There was no difference in clinical response between these two groups. Subgroup analysis showed no difference in the above outcomes between the two groups after 4 and 8 weeks of intervention. Furthermore, there was no difference between the two groups regarding nasal symptoms.
Two studies found the acupuncture group had a better quality of life, while another found the opposite result. Six trials compared acupuncture with loratadine. In addition, there was no difference between the two groups for clinical response. Compared to loratadine, acupuncture improved nasal symptoms and reduced the risk of nasal symptoms and relapse at one year.
Acupuncture plus western medicine vs. western medication alone
All trials found that combining acupuncture and western medication led to a higher proportion of clinical responses than western medication alone. By enrolling 320 participants, Ortiz et al. found that nasal symptoms were less severe in the combination group after treatment compared to western medication alone. In addition, one study found that the levels of specific cytokines, such as IL-4, IL-6, and IL-10, decreased by combining acupuncture and western medication. Another study found that adding acupuncture to medication was advantageous by reducing the levels of vascular cell adhesion molecule-1, IL-4, and IL-10.
Discussion
Results showed that for adults with moderate-to-severe AR, acupuncture is better than no intervention in reducing the severity of nasal symptoms and improving the patient’s quality of life. Acupuncture is also superior to sham acupuncture in lowering the severity of nasal symptoms and improving quality of life. Both acupuncture and western medication improve the clinical response of AR.
In addition, acupuncture plus western medication may achieve better outcomes (such as higher clinical response rate and better quality of life) than Western medication alone. Acupuncture lowers the IgE levels in serum when compared to cetirizine. Whether acupuncture can reduce the serum level of other immune molecules remains unclear.
Conclusion
The result of these allergic rhinitis acupuncture research studies concluded that for adults with AR, acupuncture is superior to no intervention and sham acupuncture. Treatments lower the severity of nasal symptoms and improve the life quality of patients. In addition, the effect of acupuncture and cetirizine/loratadine are comparable. However, unlike western medicine, acupuncture has no adverse side effects. Finally, while acupuncture may decrease the serum level of immune response molecules, more research needs to be done to confirm this finding.
Next Steps
Try acupuncture if you suffer from allergic rhinitis. Treatments are safe, and results are significant. At Raleigh Acupuncture, we have been successfully treating chronic rhinitis for years. While acupuncture may not bring complete resolution, we can significantly improve the condition, reduce symptoms, and improve the quality of daily life.
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Reference
He, M., Qin, W., Qin, Z. et al. Acupuncture for allergic rhinitis: a systematic review and meta-analysis. Eur J Med Res 27, 58 (2022). https://doi.org/10.1186/s40001-022-00682-3
Focus Keyphrase: Allergic Rhinitis Acupuncture Research
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