Evidence behind this recommendation.
Selected studies from our library that inform the recommendations on this page. Evidence grade shown when available.
Multiple acupuncture and moxibustion therapies for allergic rhinitis in adults: a network Meta-analysis of randomized controlled trials
“This study represents the first comprehensive network meta-analysis comparing multiple acupuncture and moxibustion therapies for allergic rhinitis in adults. The researchers analyzed 56 randomized controlled trials involving 4859 patients, ...”
Treatment of Allergic Rhinitis with Acupuncture Based on Pathophysiological
“Allergic rhinitis is one of the most common allergic diseases in the world, affecting between 10% and 25% of the global population, which represents more than 500 million people. This inflammatory condition of the upper airways causes symptoms such as sneezing and...”
What Is Allergic Rhinitis?
Allergic rhinitis is a chronic inflammation of the nasal mucosa mediated by immunoglobulin E (IgE), triggered by exposure to environmental allergens such as mites, pollens, animal dander, and fungi. It affects between 20% and 30% of the Brazilian population and is the most prevalent allergic disease in the world.
Classic symptoms include nasal obstruction, watery rhinorrhea, paroxysmal sneezing, and nasal pruritus — frequently accompanied by ocular pruritus, tearing, and postnasal drip. Although it is not considered a severe disease, allergic rhinitis significantly compromises quality of life: it impairs sleep, concentration, and academic and professional performance.
When conventional pharmacological treatment does not provide adequate symptom control or causes undesirable side effects, medical acupuncture represents a therapeutic alternative with solid scientific evidence for modulation of the nasal immune response.
High Prevalence
Affects up to 30% of the Brazilian population, making it the most common allergic disease in the country and one of the leading causes of medical consultation.
Functional Impact
Impairs sleep, concentration, and productivity. Patients with allergic rhinitis have a 3-fold higher risk of developing asthma.
Response to Acupuncture
Studies suggest that medical acupuncture can act on the Th1/Th2 immune response and reduce the use of rescue antihistamines in specific RCTs (ACUSAR); the dose of medications should only be adjusted by the physician.
Why Are Conventional Treatments Not Always Sufficient?
Oral antihistamines are the first-line treatment for allergic rhinitis, but they have important limitations. First-generation drugs (dexchlorpheniramine, hydroxyzine) cause significant drowsiness, compromising the ability to drive and work. Even second-generation drugs (loratadine, cetirizine), although less sedating, do not always control nasal obstruction satisfactorily.
Nasal corticosteroids (mometasone, fluticasone) are effective for obstruction, but prolonged use can cause epistaxis, mucosal dryness, and, in rare cases, septal perforation. In addition, topical decongestants such as oxymetazoline, when used for more than 3 to 5 days, cause the dreaded rebound congestion (rhinitis medicamentosa), creating a vicious cycle of dependence.
COMPARISON: CONVENTIONAL TREATMENT VS. ACUPUNCTURE
| ASPECT | CONVENTIONAL (DRUGS) | MEDICAL ACUPUNCTURE |
|---|---|---|
| Control of sneezing/rhinorrhea | Good with antihistamines | Good, with modulation of the IgE response |
| Control of nasal obstruction | Moderate; risk of rebound with decongestants | Yes, via local vasomotor regulation |
| Drowsiness | Frequent (1st generation); possible (2nd generation) | Absent |
| Long-term effects | Dependence on decongestants; epistaxis with corticosteroids | Safe long term; no dependence |
| Immune modulation | Does not modify the Th1/Th2 response | Rebalances the Th1/Th2 balance, reduces IgE |
How Does Medical Acupuncture Work in Allergic Rhinitis?
Medical acupuncture acts on allergic rhinitis by modulating the cellular immune response and reducing mast cell degranulation in the nasal mucosa. Unlike drugs that block receptors of histamine already released, acupuncture acts upstream of the allergic process, rebalancing the immune axis that generates the exaggerated reaction.
Proposed mechanisms — based mainly on experimental models and preliminary clinical studies — include modulation of the Th1/Th2 balance (attenuation of the Th2 shift typical of atopy), reduction of IgE-mediated mast cell degranulation, activation of vagal anti-inflammatory pathways, and local vasomotor regulation that decreases edema and hypersecretion of the nasal mucosa. The translation of these mechanisms into clinical effect magnitude still varies among studies.
Mechanism of Action of Acupuncture in Allergic Rhinitis
Stimulation of points in the nasal and facial region
Needles at points such as Yingxiang (LI-20) and Bitong activate afferent fibers of the trigeminal nerve, initiating local and central neuroimmunological reflexes.
Modulation of Th1/Th2 balance
Stimulation rebalances the immune response, reducing the Th2 (pro-allergic) predominance and decreasing the production of interleukins IL-4, IL-5, and IL-13, responsible for activation of mast cells and eosinophils.
Reduction of mast cell degranulation
With less Th2 signaling, there is a reduction in specific IgE levels and less activation of mast cells in the nasal mucosa, decreasing the release of histamine, leukotrienes, and prostaglandins.
Activation of the vagal anti-inflammatory pathway
Acupuncture stimulates the vagus nerve, activating the cholinergic anti-inflammatory pathway that suppresses the production of TNF-alpha and other pro-inflammatory cytokines via the alpha-7 nicotinic receptor.
Vasomotor regulation of the nasal mucosa
Modulation of the local autonomic nervous system reduces engorgement of the nasal turbinates, decreasing mucosal edema and restoring patency of the airways.
What Do the Scientific Studies Say?
Allergic rhinitis is one of the conditions with the most solid scientific evidence in favor of acupuncture. The ACUSAR study (Acupuncture in Seasonal Allergic Rhinitis), published in the Annals of Internal Medicine, is one of the largest randomized clinical trials ever conducted for acupuncture, with 422 participants. Its favorable conclusions drove the inclusion of acupuncture in international guidelines for allergic rhinitis.
What Is the Difference of the Modern Approach?
Contemporary medical acupuncture for allergic rhinitis goes beyond traditional needling. The medical acupuncturist uses protocols based on neuroimmunology, selecting points with demonstrated action on the immune system and combining techniques that potentiate the immunomodulatory effect.
Electroacupuncture at points such as Zusanli (ST-36) has demonstrated in experimental studies the ability to activate the vagal anti-inflammatory pathway more potently than manual needling. Low-level laser therapy at the nasal points is a valuable option for patients with sensitivity in the facial region, offering stimulation without discomfort.
When to See a Physician?
If you have persistent nasal obstruction, frequent sneezing, chronic rhinorrhea, or perception of progressive worsening of respiratory symptoms, consult a specialist physician. Untreated allergic rhinitis can progress to chronic sinusitis and aggravate asthma.
Frequently Asked Questions
The standard protocol involves 8 to 12 sessions, performed once or twice a week. Most patients perceive improvement of nasal symptoms from the third or fourth session. After the initial protocol, biweekly or monthly maintenance sessions — especially in periods of greater allergen exposure — help to sustain the benefit.
No. Acupuncture is a complementary therapy and does not replace antihistamines, nasal corticosteroids, or immunotherapy when indicated. In specific RCTs (ACUSAR), patients treated with acupuncture showed a reduction in the use of rescue antihistamines compared with control, but this dose adjustment is always the decision of the attending physician, based on the individual clinical response. Never reduce or discontinue medication on your own.
The most commonly used points are next to the wings of the nose (Yingxiang) and in the frontal region (Shangxing, Yintang). The insertion is superficial and causes minimal discomfort — very different from an injection. Most patients report only a slight local pressure. For those with high facial sensitivity, the physician may use laser therapy at these points.
Yes, there are studies demonstrating the efficacy of acupuncture in children with allergic rhinitis. For pediatric patients, the medical acupuncturist may use non-invasive techniques such as laser therapy, auriculotherapy with mustard seeds or microspheres, and stimulation with pressure on the points (acupressure), which are well tolerated by children.
Acupuncture acts on both fronts. In the short term, it relieves symptoms (obstruction, sneezing, rhinorrhea) through nasal vasomotor regulation. In the medium and long term, it modulates the Th1/Th2 balance of the immune system, reducing the underlying allergic hypersensitivity. This immunomodulatory action is what differentiates acupuncture from antihistamines, which act exclusively on symptoms.
Acupuncture can be performed both during a flare and outside of it. During the flare, needling at local nasal points provides rapid relief from obstruction and sneezing. Outside the flare, treatment focuses on preventive immunomodulation. Ideally, the protocol combines both approaches for acute control and prevention of new flares.