Acupuncture and allergic rhinitis

Allergic rhinitis affects approximately 60 million people in the United States, causing significant impact on quality of life, work productivity, and school absenteeism. Due to the limitations of conventional treatment, many patients seek complementary therapies, with about 20% receiving acupuncture. This narrative review systematically analyzes the medical literature from January 2013 to December 2014 to evaluate the efficacy, effectiveness, safety, and cost-effectiveness of acupuncture in the treatment of allergic rhinitis. The search identified five high-quality randomized clinical trials that enrolled 1,413 participants in total.

The most robust study was the multicenter trial conducted by Brinkhaus et al., which evaluated 422 patients with seasonal allergic rhinitis divided into three groups: true acupuncture with rescue medication (cetirizine), sham acupuncture with rescue medication, and rescue medication alone. Participants received 12 treatments over 8 weeks and were assessed for rhinitis-related quality of life (RQLQ) and rescue medication use. The results demonstrated statistically significant improvements of 0.5 and 1.1 points on the RQLQ and rescue medication score, respectively, when true acupuncture was compared to sham acupuncture, and improvements of 0.7 and 1.5 points when compared to rescue medication alone. Another important multicenter study, conducted by Choi et al.

with 238 patients with perennial allergic rhinitis, compared true acupuncture with sham acupuncture and a waitlist control group. After 12 treatments over 4 weeks, statistically significant improvements of 1.03 and 1.09 points were observed in the Total Nasal Symptom Score at 4 and 8 weeks, respectively, compared with sham acupuncture, and an improvement of 2.49 points at 4 weeks compared with the control group. Smaller head-to-head studies of acupuncture versus antihistamines showed results favoring acupuncture, although with methodological limitations. The Hauswald et al.

study with 24 patients demonstrated 87% improvement with acupuncture versus 67% with loratadine at 6 weeks, with benefits persisting for 16 weeks (80% versus 0%). Additional Chinese studies reported improvement rates of 94-95% with acupuncture versus 73-83% with conventional medications. Regarding safety, acupuncture was well tolerated. Extensive prospective studies revealed minor adverse event rates between 7.1% and 13 per 100,000 treatments, primarily consisting of mild bleeding at the insertion site, transient pain, and erythema.

Serious adverse events are extremely rare when treatment is administered by well-trained practitioners. Even in patients on anticoagulants, the rate of microhemorrhage was low (4.8%) and well tolerated. The cost-effectiveness analysis yielded mixed results. Although acupuncture initially demonstrated higher costs, analysis over longer time horizons (16 weeks) showed better cost-effectiveness, with statistically significant improvement in quality-adjusted life years compared with the group that received rescue medication alone.

The review concludes that there are high-quality randomized clinical trials demonstrating efficacy and effectiveness of acupuncture for seasonal and perennial allergic rhinitis. Acupuncture was superior to placebo and comparable to or superior to antihistamines, with a favorable safety profile. The authors emphasize the need for higher-quality and larger comparative effectiveness research, including head-to-head comparisons with topical intranasal corticosteroids and, for refractory cases, with immunotherapy. The US Institute of Medicine identified complementary medicine and otorhinolaryngologic disorders as priority areas for comparative effectiveness research, aligning with this review's recommendations for more robust future studies that adequately evaluate the role of acupuncture in the management of allergic rhinitis.