Acupuncture for allergic rhinitis: a systematic review and meta-analysis

Allergic rhinitis is one of the most common respiratory conditions in the world, affecting approximately 1.4 billion people globally. This disease results from an immune reaction mediated by IgE antibodies when a person is exposed to allergens, causing nasal symptoms that can significantly compromise quality of life. Although it is not a life-threatening condition, allergic rhinitis can lead to complications such as bronchial asthma, sinusitis, and allergic conjunctivitis, interfering with work and daily activities. Conventional treatments include antihistamine medications such as loratadine and cetirizine, topical corticosteroids, and immunotherapy, which are effective but can cause side effects such as nasal bleeding, dry eyes, and drowsiness.

Many patients seek non-pharmacologic alternatives, which has sparked growing interest in acupuncture as a therapeutic option.

Chinese and German researchers conducted a comprehensive systematic review to evaluate the efficacy and safety of acupuncture in the treatment of allergic rhinitis. The study rigorously followed Cochrane methodological standards and included only randomized controlled clinical trials that compared acupuncture with other therapies for allergic rhinitis. The methodology involved a systematic search of multiple medical databases, including studies published through February 2018. The researchers analyzed 30 studies involving 4,413 participants from various countries including Australia, China, Germany, South Korea, and Sweden.

The studies compared different acupuncture techniques, including manual acupuncture, electroacupuncture, and moxibustion, with controls that included no treatment, sham acupuncture, and medications such as cetirizine and loratadine. To ensure the robustness of the results, the authors applied a trial sequential analysis, an advanced statistical tool that tests whether there is sufficient evidence to support the conclusions.

The results demonstrated promising benefits of acupuncture in adults with allergic rhinitis. When compared with no treatment, acupuncture showed significant improvements in both nasal symptoms and patients' quality of life, measured through validated questionnaires. The studies also showed that real acupuncture was superior to sham acupuncture, in which needles are inserted superficially at points unrelated to traditional meridians, demonstrating that the observed effects are not merely placebo. Specifically, acupuncture reduced nasal symptom scores and significantly improved rhinoconjunctivitis-related quality of life.

When compared with antihistamine medications such as cetirizine and loratadine, acupuncture showed similar efficacy, suggesting that it may be a valid alternative for patients who prefer non-pharmacologic treatments or who experience side effects with conventional medications. Interestingly, the combination of acupuncture with Western medications demonstrated superior results to the isolated use of medications.

For patients and healthcare professionals, these findings suggest that acupuncture can be considered a legitimate therapeutic option for adults with moderate to severe allergic rhinitis. Acupuncture has shown to be particularly beneficial in improving symptoms such as nasal obstruction, runny nose, itching, and sneezing, as well as contributing to better overall quality of life. The adverse effects reported were minimal and included mainly mild discomfort at the needle insertion site, transient pain, and rarely small hematomas or fatigue after treatment. For medical professionals, the results indicate that acupuncture can be integrated into treatment protocols, especially for patients who do not respond well to conventional treatments or who prefer complementary approaches.

The evidence also suggests that acupuncture may have beneficial effects on serum IgE levels, an important marker of the allergic response, although further research is needed to confirm these immunologic findings.

The study presents some important limitations that should be considered in interpreting the results. The trial sequential analysis revealed that, despite positive results, there is still insufficient evidence for definitive conclusions, indicating the need for further research. Most of the included studies presented a high risk of performance bias, since it is difficult to fully "blind" patients and therapists in acupuncture studies. There was also significant variability across studies in terms of acupuncture techniques used, points selected, frequency, and duration of treatments, which may influence the results.

Data on the efficacy of acupuncture in children and adolescents were insufficient, limiting recommendations for this age group. Additionally, studies comparing acupuncture with conventional medications were conducted predominantly in China, which may introduce cultural bias in treatment preferences. The researchers emphasize that future studies should have better methodological quality, include more diverse populations, and establish standardized acupuncture protocols to allow more accurate comparisons and more robust conclusions about this promising therapeutic modality for allergic rhinitis.