Efficacy, effectiveness and cost-effectiveness of acupuncture for allergic rhinitis — An overview about previous and ongoing studies

Allergic rhinitis has become a major public health concern, with direct costs estimated between €1–1.5 billion per year in Europe and indirect costs of €1–2 billion. A substantial number of patients seek complementary medicine for symptom relief, with acupuncture use prevalence ranging from 17–19% in this population. This narrative review examined studies on acupuncture for allergic rhinitis, including only clinical trials with at least 30 participants, a minimum of 6 acupuncture sessions, and publication in English. Allergic rhinitis was divided into seasonal (SAR) and perennial (PAR) forms for analysis.

For seasonal allergic rhinitis, three studies compared acupuncture with sham acupuncture, but only one showed a significant difference. The Xue et al. (2002) study was a randomized crossover trial with 30 participants that found significant differences in nasal and non-nasal symptom scores. The other two studies (Williamson et al.

and Magnusson et al.) did not demonstrate superiority of acupuncture over sham control. An additional study investigated the combination of acupuncture with Chinese herbal medicine, showing positive results. For perennial allergic rhinitis, the evidence appears more promising. Three studies showed favorable results: Ng et al.

(2004) tested acupuncture in 72 children and found significantly lower daily rhinitis scores and more symptom-free days in the acupuncture group. Xue et al. (2007) studied 80 adults and found significant improvement in total nasal symptoms after 8 weeks. Li et al.

(2007) compared electroacupuncture with medication in 100 patients, showing superior efficacy of electroacupuncture. The largest study was the Acupuncture in Routine Care (ARC) trial, a German pragmatic study with 981 randomized patients that assessed effectiveness and cost-effectiveness of additional acupuncture. Participants received up to 15 acupuncture sessions over 3 months. The acupuncture group showed significant improvement in rhinitis-specific quality of life (RQLQ) of 1.48 points versus 0.50 in controls.

The economic analysis revealed a cost of €17,377 per quality-adjusted life-year (QALY), more favorable for women (€10,155) than men (€44,871). Total costs were higher in the acupuncture group (€763 vs €332), but there was a significant gain in quality of life. Two large trials are ongoing to provide additional evidence. The ACUSAR study investigates whether acupuncture is non-inferior or superior to sham acupuncture and rescue medication in 422 patients with SAR.

Another China–Korea multicenter study is evaluating 238 patients with PAR. The methodological heterogeneity of the studies is an important limitation. Although most used penetrating sham controls, these ranged from superficial insertion at acupuncture points to superficial insertion at non-acupuncture points. Few studies included medication control groups.

The clinical implications suggest that there is insufficient evidence for a specific effect of acupuncture in seasonal rhinitis, but promising evidence for perennial rhinitis. Acupuncture as an add-on treatment has been shown to be beneficial and relatively cost-effective. The pragmatic approach of the ARC study provides real-world evidence on effectiveness, complementing efficacy studies. The authors emphasize the need for larger studies for more rigorous conclusions, given that most published efficacy studies are small.

Variability in acupuncture protocols, inclusion criteria, and outcome measures makes direct comparisons between studies difficult.