Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial

doi:10.1016/S1081-1206(10)60294-3

Annals of Allergy, Asthma & Immunology

Volume 101, Issue 5, November 2008, Pages 535-543

https://doi.org/10.1016/S1081-1206(10)60294-3 Get rights and content

Background

Acupuncture is widely used in patients with allergic rhinitis, but the available evidence of its effectiveness is insufficient.

Objective

To evaluate the effectiveness of acupuncture in addition to routine care in patients with allergic rhinitis compared with treatment with routine care alone.

Methods

In a randomized controlled trial, patients with allergic rhinitis were randomly allocated to receive up to 15 acupuncture sessions during a period of 3 months or to a control group receiving no acupuncture. Patients who did not consent to random assignment received acupuncture treatment. All patients were allowed to receive usual medical care. The Rhinitis Quality of Life Questionnaire (RQLQ) and general health-related quality of life (36-Item Short-Form Health Survey) were evaluated at baseline and after 3 and 6 months.

Results

Of 5,237 patients (mean [SD] age, 40 [12] years; 62% women), 487 were randomly assigned to acupuncture and 494 to control, and 4,256 were included in the nonrandomized acupuncture group. At 3 months, the RQLQ improved by a mean (SE) of 1.48 (0.06) in the acupuncture group and by 0.50 (0.06) in the control group (3-month scores, 1.44 [0.06] and 2.42 [0.06], respectively; difference in improvement, 0.98 [0.08]; P < .001). Similarly, quality-of-life improvements were more pronounced in the acupuncture vs the control group (P < .001). Six-month improvements in both acupuncture groups were lower than they had been at 3 months.

Conclusions

The results of this trial suggest that treating patients with allergic rhinitis in routine care with additional acupuncture leads to clinically relevant and persistent benefits. In addition, it seems that physician characteristics play a minor role in the effectiveness of acupuncture treatment, although this idea needs further investigation.

Section snippets

INTRODUCTION

Despite advances in conventional therapy, a remarkable number of patients with allergic rhinitis are turning for relief to complementary medical treatments.1, 2

Acupuncture is widely used for the treatment of allergic rhinitis²; however, several studies on its efficacy in patients with allergic rhinitis have yielded inconclusive results.3, 4, 5, 6, 7, 8 For example, Xue et al⁵ and Ng et al⁸ demonstrated that acupuncture is effective in reducing subjective allergic rhinitis symptom scores,

Design

In accordance with German federal regulations, the participating health insurance companies covered 100% of the acupuncture costs for patients who agreed to randomization and 90% of the costs for patients who participated in the study but did not agree to randomization. The Acupuncture in Routine Care Study was a multicenter randomized controlled trial plus a nonrandomized cohort (Fig 1). Patients who agreed to randomization were allocated to an acupuncture group that received immediate

Study Population and Treatment

Between December 2000 and August 2001, a total of 5,324 patients with allergic rhinitis were recruited for the study by 2,274 study physicians (Fig 2 for patient selection). A total of 1,068 patients had accepted randomization and were allocated to acupuncture or control group. Eighty-seven patients (48 acupuncture, 39 control) could not be included in the analysis because the study office did not receive the consent form or the patients did not receive the study intervention. The remaining

DISCUSSION

Patients with allergic rhinitis treated with acupuncture in addition to routine care showed significant improvements in disease-specific and general quality of life compared with patients who received routine care alone. Physician characteristics, such as the level of formal acupuncture training or certification, did not influence treatment outcomes.

To our knowledge, the present study is by far the largest randomized trial of acupuncture in allergic rhinitis to date, including approximately

ACKNOWLEDGMENTS

We thank Katja Wruck for data management; Iris Bartsch, Beatrice Eden, Dagmar Selim, and Sigrid Mank for data acquisition; and the members of the advisory board (Konrad Beyer, MD, Josef Hummelsberger, MD, Hardy Müller, PhD, Albrecht Molsberger, MD, Helmut Rüdinger, MD, Wolfram Stör, MD, and Gabriel Stux, MD) for helpful advice. We also thank all participating physicians and patients.

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A total of 10,942 articles published from January 2012 to August 2022 were analysed. A total of 97 countries and regions have conducted acupuncture research, with the highest number of research conducted in China. Furthermore, 8,056 institutions were involved in acupuncture research. In addition, 1,823 journals have published articles related to acupuncture research, with the highest number published by the journal Evid-Based Compl Alt (1,096 articles). The hotspots of acupuncture research are acupuncture analgesia (low back pain, knee osteoarthritis, headache, shoulder pain, neck pain, cancer pain, migraine), acupuncture anti-inflammatory (allergic rhinitis [AR], inflammatory pain), female-related diseases (polycystic ovary syndrome and breast cancer), cerebrovascular diseases (stroke and hemiplegia), rehabilitation treatment (postoperative nausea and vomiting, postoperative pain, and trauma pain in veterans), resting functional magnetic resonance imaging (fMRI), nervous system diseases (nerve regeneration and neuroprotection), depression, insomnia, Alzheimer's disease (AD), evidence-based researches, etc.
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Filiform needle acupuncture for allergic rhinitis: A systematic review and meta-analysis
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Citation Excerpt :
Fifteen studies [37,38,40,41,43–46,49–52,55,57,62] compared FNA with conventional medication, including loratadine, cetirizine, chlorpheniramine, or the combination of loratadine and azelastine hydrochloride nasal spray. For the outcomes, symptom score (14 trials [38–43,45,48–50,53,56,58,61]), QoL score (13 trials [38,39,41,42,45,47,48,50,53,55,56,58,60]), total IgE level (10 trials [37,39,41,44,47,50,51,62–64]), medication score (5 trials [48,53,61,63,65]), treatment costs (2 trials [54,59]), ICER (2 trials [54,59]), and patient satisfaction score (1 trial [60]) were reported. Sixteen studies included adverse event rates [37,39,44,46–48,50,52,53,56–58,61,63,65,66].
Filiform needle acupuncture (FNA), the most classical and widely applied acupuncture method based on traditional Chinese medicine theory, has shown a promising effect in the treatment of allergic rhinitis (AR).
To evaluate the efficacy, safety, cost-effectiveness, and patient preference of FNA in the treatment of AR by comparing FNA with sham acupuncture, no treatment, and conventional medication.
Eight electronic databases were systematically searched from inception to October 14, 2021. Additional studies were acquired from clinical trial registration platforms and reference lists.
Randomized controlled trials were included if they compared FNA with either sham acupuncture, no treatment or conventional medication for AR.
Two researchers extracted data independently of each other using a predesigned data acquisition form, and results were cross-checked after completion. The primary outcome was symptom score (Total Nasal Symptom Score or Visual Analogue Scale), and the secondary outcomes were the AR control questionnaire, quality of life (QoL) score (Different versions of Rhinoconjunctivitis Quality of Life Questionnaire), medication score (use of rescue medication), mental health score, total IgE, adverse event rate, clinical economic indicators, and patient satisfaction score. Standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval was used to calculate the effect size for continuous data, while risk ratio with 95% CI was used for dichotomous data.
Thirty studies were included in this review. Compared with sham acupuncture, FNA significantly reduced the symptom score (SMD: −0.29 [−0.43, −0.15]), AR’s impact on QoL (SMD: −0.23 [−0.37, −0.08]) and medication score (SMD: −0.3 [−0.49, −0.11]). Compared with no treatment, FNA dramatically reduced the symptom score (SMD: −0.8 [−1.2, −0.39]) and AR’s impact on QoL (SMD: −0.82 [−1.13, −0.52]). There were no increased rates of adverse events with FNA compared to sham acupuncture and no treatment. FNA increased patient satisfaction and may be cost-effective. Most pieces of evidence from the above two comparisons were of high confidence. Moreover, FNA significantly outperformed conventional medication in reducing the symptom score (SMD: −0.48 [−0.85, −0.1]) and displayed a lower rate of adverse events, but the quality of evidence was very low.
FNA is an effective and safe intervention for AR and can help with symptom relief, QoL improvement, reducing medication usage, and increasing patient satisfaction. Further studies are needed to verify its cost-effectiveness and superiority over conventional medication and the best therapeutic strategies.
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International consensus statement on allergy and rhinology: Allergic rhinitis – 2023
2023, International Forum of Allergy and Rhinology
Acupuncture for allergic rhinitis: a systematic review and meta-analysis
2022, European Journal of Medical Research

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Disclosures: Authors have nothing to disclose.

Funding Sources: This study was funded by social health funds. including the Techniker Krankenkasse; Betriebskankankasse, DaimlerChrysler, Bertelsmann, Siemens-Betriebskankankasse, Betriebskankankasse Deutsche Bank, Betriebskankankasse Hoechst, HypoVereinsbank Betriebskankankasse, Ford Betriebskankankasse, Betriebskankankasse der Allianz Gesellschaften, Vereins und Westbank BKK, Handelskrankenkasse, and Innungskrankankassee Hamburg.

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Original Articles: InterventionsAcupuncture in patients with allergic rhinitis: a pragmatic randomized trial

Background

Objective

Methods

Results

Conclusions

Section snippets

INTRODUCTION

Design

Study Population and Treatment

DISCUSSION

ACKNOWLEDGMENTS

J Allergy Clin Immunol.

J Allergy Clin Immunol.

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Laryngoscope.

Alternative medicine in allergies: prevalence, patterns of use, and costs

Allergy.

Acupuncture for persistent allergic rhinitis: a randomised, sham-controlled trial

Med J Aust.

Protective effect of acupuncture on allergen provoked rhinitis

Wien Med Wochenschr.

Effect of acupuncture in the treatment of seasonal allergic rhinitis: a randomized controlled clinical trial

Am J Chin Med.

Acupuncture and Chinese herbal medicine in the treatment of patients with seasonal allergic rhinitis: a randomized-controlled clinical trial

Allergy.

The effect of acupuncture on allergic rhinitis: a randomized controlled clinical trial

Am J Chin Med.

A double-blind, randomized, placebo-controlled trial of acupuncture for the treatment of childhood persistent allergic rhinitis

Pediatrics.

Original Articles: Interventions
Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial