Allergic rhinitis affects between 10% and 40% of the world population and is considered a global public health problem, with direct impact on productivity, sleep quality, and cognitive function of patients. Despite the availability of antihistamines, nasal corticosteroids, and allergen-specific immunotherapy, a significant share of patients does not obtain satisfactory symptom control or has intolerance to medications. Intranasal acupuncture — a variant that applies needles directly to the nasal mucosa, stimulating points such as Bitong (EX-HN8) and Yingxiang (LI-20 intranasal) — has been used in traditional Chinese medicine for rhinitis for centuries, but only recently has undergone rigorous systematic evaluation. A meta-analysis published in Medicine (Baltimore) in November 2024 pooled 14 randomized clinical trials and 1,009 patients to evaluate this approach.
The study was conducted by Li Y, Wang Y, Liang Y, Si X, Li Z, Wang Y, and colleagues, with searches conducted in PubMed, Cochrane, Embase, and Chinese databases through August 2024. Outcomes evaluated were: total nasal symptom score (TNSS — Total Nasal Symptom Score, which evaluates nasal obstruction, rhinorrhea, sneezing, and nasal pruritus), total non-nasal symptom score (TNNSS — evaluates ocular pruritus, lacrimation, and palatal pruritus), the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ), and visual analogue scale of global symptoms (VAS). The comparator was conventional pharmacologic treatment (oral antihistamines, nasal corticosteroids, or combination).
MAIN RESULTS — 14 RCTS, 1,009 PATIENTS
What is intranasal acupuncture and how is it performed?
Intranasal acupuncture is a specialized modality that differs from conventional acupuncture in the location of the stimulation points: inside the nasal cavity, on the mucosa lining the conchae and nasal septum. The most-used points are Bitong (EX-HN8, at the inner angle of the nostril), Yingxiang (LI-20, modified for intranasal application), and the Neiyingxiang point (extra acupoint located inside the nostril). The technique uses very fine needles (0.16×15–25 mm), inserted with precision into the submucosal tissue after adequate cleaning with saline. The richness of nasal innervation — with terminations of the trigeminal, olfactory, and autonomic nerves — together with the dense network of mast cells and immune cells in the nasal mucosa, creates a high-responsiveness environment for acupuncture stimulation. The technique requires specific training and should be performed exclusively by a physician with experience in nasal acupuncture.
Quality of life results: the most relevant outcome for the patient
Improvement in the RQLQ (Rhinoconjunctivitis Quality of Life Questionnaire) is clinically the most important outcome of this meta-analysis, since it evaluates the real impact of rhinitis on the patient’s daily life: sleep, physical activity, work, social activities, and emotional well-being. Allergic rhinitis reduces, on average, 1.5 hours of productivity per day during peaks of allergic exposure and increases by 40% the risk of chronic insomnia. Significant improvement in the RQLQ in comparison with conventional pharmacotherapy suggests that intranasal acupuncture not only relieves isolated symptoms — it improves the patient’s overall functioning during the allergic season. This is especially relevant for patients with persistent moderate-severe rhinitis, where symptomatic control with conventional antihistamines is frequently insufficient.
Frequently Asked Questions
The nasal mucosa is well innervated, and the sensation at the moment of insertion may be uncomfortable — a sensation of pressure or tingling locally, different from acute pain. Most patients tolerate it well after the first session, when anticipatory anxiety is greater. The use of very fine needles (0.16 mm in diameter) and slow, controlled insertion minimize discomfort. After insertion, the sensation of distension in the mucosa (similar to the classical “de qi” of acupuncture) is indicative of adequate stimulation. In children or very anxious patients, the technique with auricular seeds or acupuncture at external facial points may be preferred as the first approach.
Yes — there is no contraindication to the combination of intranasal acupuncture with subcutaneous or sublingual allergen-specific immunotherapy. The two approaches act through complementary mechanisms: immunotherapy modifies the immunologic response in an allergen-specific way (desensitization), while acupuncture modulates the inflammatory response in a more nonspecific way. In practice, it is recommended not to perform the acupuncture session on the same day as the immunotherapy injection, to facilitate monitoring of any reactions and avoid confusion about the cause of possible adverse effects.
Yes — pediatric allergic rhinitis is an appropriate indication for acupuncture, with technical adaptations for the age group. In children younger than 8 years, intranasal acupuncture is rarely used because of the difficulty of cooperation. For this age group, the usual protocol includes auriculotherapy with seeds (excellent tolerance), conventional acupuncture with fine needles at facial and distal points (10–15-minute sessions), and acupressure that parents can perform at home at points such as LI-20, LI-4, and ST-36. In cooperative adolescents, the complete intranasal technique may be considered with adequate preparation.
Fonte Original
Medicine (Baltimore)(em inglês)Founded in 1989 by physicians trained at the University of São Paulo (USP) and specialized in China, CEIMEC is a Brazilian national reference in the teaching and practice of medical acupuncture. With more than 3,000 physicians trained over 35 years, it collaborates with HC-FMUSP and is recognized by the Brazilian Medical College of Acupuncture (CMBA/AMB).