A multicenter, randomized, controlled trial testing the effects of acupuncture on allergic rhinitis

Allergic rhinitis is a common condition that affects between 17–29% of the European population and causes symptoms such as runny nose, nasal itching, obstruction, and sneezing. These symptoms can impair sleep and concentration during the day and also represent a significant economic burden. Conventional treatments include antihistamines, intranasal corticosteroids, and immunotherapy, but they often cause undesirable side effects and do not always provide complete symptom relief. This multinational study was the first to rigorously evaluate the efficacy of acupuncture for persistent allergic rhinitis (PAR).

The study was conducted at four medical centers in South Korea and China, between March and December 2009. Two hundred thirty-eight adults with moderate to severe persistent allergic rhinitis, confirmed by skin allergy testing, participated. Participants were randomized into three groups: verum acupuncture (97 people), sham acupuncture (94 people), and waitlist (47 people). The verum acupuncture group received treatment at 10 specific points (LI-4, LI-20, ST-2, ST-36 bilaterally, and EX-1 and GV-23 unilaterally), with needles inserted until de qi sensation was obtained.

The sham acupuncture group received superficial needle insertion at non-acupuncture points, located 1–1.5 cm away from the verum points, avoiding the de qi sensation. Both groups received 12 sessions over 4 weeks. The waitlist group received no treatment during the study period. Results were measured using the Total Nasal Symptom Score (TNSS), which assesses nasal obstruction, runny nose, sneezing, and itching on a scale of 0–4 for each symptom.

Non-nasal symptoms and quality of life were also evaluated using the RQLQ questionnaire. After 4 weeks of treatment, the verum acupuncture group showed significantly greater reduction in nasal symptoms compared with the sham acupuncture group (difference of 1.03 points, P=0.03) and the waitlist group (difference of 2.49 points, P<0.0001). The effect size between verum and sham acupuncture was 0.3, while between verum acupuncture and waitlist it was 0.7. Interestingly, both verum and sham acupuncture showed significant improvements compared with baseline, suggesting that even minimal stimulation may have some therapeutic effect.

The benefits of verum acupuncture persisted for more than 4 weeks after the end of treatment, indicating lasting effects. Regarding quality of life, measured by the RQLQ, there were significant improvements in the verum acupuncture group compared with the waitlist group, but differences between verum and sham acupuncture were less consistent, except in the sleep domain. Participant blinding was effective, with similar proportions of people believing they had received verum acupuncture in both treatment groups. In terms of safety, only one serious adverse event was reported (hospitalization for enteritis in the sham acupuncture group), which was not considered treatment-related.

Other adverse effects were mild and transient. This study has several important limitations. First, the effect size between verum and sham acupuncture was relatively small (0.3), which may raise questions about the clinical relevance of the difference. Second, it is possible that sham acupuncture produced real physiological effects due to skin stimulation, which could diminish differences between groups.

Third, some participants were using prohibited medications that were only discovered after randomization. Despite these limitations, this study provides robust evidence that acupuncture is more effective than placebo or no treatment for persistent allergic rhinitis. The results suggest that acupuncture may be considered a safe and effective therapeutic option for patients seeking alternatives to conventional treatments or who have not achieved adequate relief with standard medications.