The Anti-Inflammatory Effects of Acupuncture and Their Relevance to Allergic Rhinitis: A Narrative Review and Proposed Model
McDonald et al. · Evidence-Based Complementary and Alternative Medicine · 2013
Evidence Level
MODERATEOBJECTIVE
To investigate the anti-inflammatory mechanisms of acupuncture and their relevance to allergic rhinitis
FOCUS
Analysis of cytokines, neuropeptides, and neurotrophins
MODEL
Proposal of an integrated theoretical model
MECHANISMS
HPA axis, sympathetic system, and cholinergic pathways
🔬 Study Design
literature review
n=0
theoretical analysis of mechanisms
📊 Results in numbers
IL-10 reduction
SP and VIP reduction
Th1/Th2 modulation
TRPV1 inhibition
📊 Outcome Comparison
anti-inflammatory effects
This theoretical study explains how acupuncture may help people with allergic rhinitis through several mechanisms in the body that reduce inflammation. The researchers propose that acupuncture works by decreasing substances that cause inflammation and rebalancing the immune system.
Article summary
Plain-language narrative summary
This narrative review study provides a comprehensive analysis of the anti-inflammatory mechanisms of acupuncture and their specific relevance to the treatment of allergic rhinitis. The authors conducted extensive searches in multiple databases and specialty journals to identify research on the pathophysiology of allergic rhinitis and the anti-inflammatory actions of acupuncture.
Allergic rhinitis is a complex inflammatory condition that affects 18% of young adults globally, involving an IgE-mediated cascade of events that results in mast cell degranulation and the release of inflammatory mediators. The study details how the allergic response involves two phases: an early response characterized by sneezing, nasal itching, and rhinorrhea, and a late response dominated by nasal congestion due to the influx of eosinophils, basophils, and neutrophils.
The researchers identified three main categories of mediators in allergic rhinitis: pro-inflammatory neuropeptides (substance P, CGRP, VIP), cytokines (especially the Th1/Th2 imbalance), and neurotrophins (NGF, BDNF). These mediators interact in a complex network that perpetuates and amplifies the allergic inflammatory response.
Regarding the anti-inflammatory mechanisms of acupuncture, the study reveals that multiple physiological pathways mediate these effects. The hypothalamic-pituitary-adrenal (HPA) axis was shown to mediate the anti-edema effects of acupuncture, but not its anti-hyperalgesic actions. Sympathetic pathways, both through postganglionic neurons and the sympatho-adrenomedullary axis, also contribute to the anti-inflammatory effects.
The research documents significant antihistaminic effects of acupuncture, with studies showing reduced histamine-induced itching and wheal formation in healthy individuals. Studies in patients with allergic rhinitis demonstrated favorable changes in the Th1/Th2 balance, with significant reductions in Th2 cytokines such as IL-4 and IL-10, and increases in IFN-γ.
A particularly interesting finding was the demonstration that acupuncture can modulate pro-inflammatory neuropeptides. A study comparing electroacupuncture with conventional medication showed significant reductions in substance P and VIP, with electroacupuncture producing a greater reduction in VIP than medication. These reductions correlated with improvements in clinical signs and symptoms.
The study also explores the crucial role of the TRPV1 receptor in the early allergic response and how acupuncture may inhibit its signaling. TRPV1 mediates the production of pro-inflammatory neuropeptides and is activated by histamine released by mast cells, creating a positive feedback loop that amplifies inflammation.
Based on this analysis, the authors propose an integrated theoretical model suggesting that acupuncture exerts anti-inflammatory effects in allergic rhinitis through three main mechanisms: cytokine modulation (reducing Th2 and pro-inflammatory cytokines, increasing Th1), reduction of pro-inflammatory neuropeptides (SP, CGRP, VIP), and decrease in neurotrophins (NGF, BDNF). These actions converge to reduce mast cell degranulation, vasodilation, plasma extravasation, and inflammatory cell survival.
The clinical implications are significant, as this model provides a rational basis for the use of acupuncture in allergic rhinitis and guides future research. The study suggests that the clinical efficacy of acupuncture may result from its unique ability to simultaneously modulate multiple inflammatory pathways, offering a more holistic approach than conventional treatments focused on single mediators.
Strengths
- 1comprehensive literature review with systematic search
- 2integrated analysis of multiple anti-inflammatory pathways
- 3proposal of an innovative theoretical model
- 4correlation between basic mechanisms and clinical efficacy
Limitations
- 1theoretical nature without direct experimental validation
- 2clinical evidence still limited for some mechanisms
- 3need for more studies to confirm the proposed model
- 4lack of standardization in the acupuncture protocols analyzed
Expert Commentary
Prof. Dr. Hong Jin Pai
PhD in Sciences, University of São Paulo
▸ Clinical Relevance
Allergic rhinitis affects a significant share of the economically active population, and despite the available pharmacological arsenal — antihistamines, intranasal corticosteroids, immunotherapy — a considerable fraction of patients remain with unsatisfactory symptom control or intolerance to medication side effects. This work provides clinicians with a solid mechanistic framework to integrate acupuncture into the management of allergic rhinitis, going beyond clinical empiricism. The model proposed by the authors is particularly useful in scenarios with overlapping neuronal sensitization and immune imbalance, such as in moderate to severe persistent rhinitis with a prominent neurogenic component. Patients on chronic antihistamines without adequate control of the late phase and nasal congestion make up the population most likely to benefit from an approach that acts simultaneously on neuropeptides, the neuroendocrine axis, and the Th1/Th2 balance.
▸ Notable Findings
The most noteworthy aspect of this review is the convergence of three mechanistic axes — cytokine modulation, reduction of pro-inflammatory neuropeptides, and attenuation of neurotrophins — toward a common effect of mast cell stabilization and reduced cellular recruitment. The superiority of electroacupuncture over conventional medication in reducing VIP is a finding that deserves attention, since vasoactive intestinal peptide actively participates in vasodilation and plasma extravasation in the nasal mucosa. Equally relevant is the proposed role of the TRPV1 receptor: by inhibiting this channel, acupuncture potentially interrupts the feedback loop between histamine, mast cells, and nociceptive fibers — a mechanism that explains why patients with intense nasal hyperreactivity often report early symptomatic relief. HPA axis modulation mediating anti-edema effects but not anti-hyperalgesic effects indicates that different components of the clinical picture respond through distinct pathways.
▸ From My Experience
In my practice with the Acupuncture Group of the Pain Center at HC-FMUSP, I have followed patients with persistent allergic rhinitis referred by otolaryngologists after incomplete response to conventional treatment. What the model proposed in this article theoretically formalizes corresponds to what we observe clinically: symptomatic response tends to appear between the third and fifth sessions, with more evident improvement in early-phase symptoms — sneezing and itching — before nasal congestion subsides. I usually work with protocols that combine local points in the nasal region with systemic points recognized for immunomodulatory action, frequently combining acupuncture with environmental counseling and, when indicated, maintenance of immunotherapy. The patient profile that responds best, in my experience, is the one with mixed-pattern rhinitis — allergic and neurogenic — where nonspecific hyperreactivity is the dominant component. For maintenance, monthly sessions throughout the season of greatest allergen exposure have shown sustained results across successive seasons.
Full original article
Read the full scientific study
Evidence-Based Complementary and Alternative Medicine · 2013
DOI: 10.1155/2013/591796
Access original articleScientific Review
Marcus Yu Bin Pai, MD, PhD
CRM-SP: 158074 | RQE: 65523 · 65524 · 655241
PhD in Health Sciences, University of São Paulo. Board-certified in Pain Medicine, Physical Medicine and Rehabilitation, and Medical Acupuncture. Scientific review and curation of every entry in this library.
Learn more about the author →Medical disclaimer: This content is for educational purposes only and does not replace consultation, diagnosis, or treatment by a qualified professional. Some information may be assisted by artificial intelligence and is subject to inaccuracies. Always consult a physician.
Content reviewed by the medical team at CEIMEC — Integrated Centre for Chinese Medicine Studies, a reference in Medical Acupuncture for over 30 years.
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