Rédacteurs : Johan Nguyen, Claude Pernice

Sommaire

allergic rhinitis:

Rhinite allergique : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆ Evidence for effectiveness and a specific effect of acupuncture
☆☆ Evidence for effectiveness of acupuncture
Limited evidence for effectiveness of acupuncture
Ø No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Yin 2020

Yin Z, Geng G, Xu G, Zhao L, Liang F. Acupuncture methods for allergic rhinitis: a systematic review and bayesian meta-analysis of randomized controlled trials. Chin Med. 2020. [212693]. doi

Background Allergic rhinitis (AR) is a common symptomatic, inflammatory, and immunological disorder of nasal mucosa. Multiple clinical trials and systematic reviews have implicated acupuncture methods as potentially effective treatment strategies for AR, however, considering the great burden of AR, it is crucial to explore the most recent clinical evidence supporting acupuncture in AR. Besides, the methodologies reported in previous studies as well as those commonly applied during clinical practices greatly vary. Herein, we conducted network meta-analysis to compare the effectiveness of diverse acupuncture methods for AR treatment.
MethodsWe conducted a literature search for relevant reports published from inception to 1 July 2020 in several scientific databases, including PubMed, Embase, Cochrane library, Web of Science, CNKI, WF, VIP, CBM, AMED as well as related registration platforms. Primary outcomes as reported in the identified studies were assessed using nasal symptoms. All Meta-analyses were performed with RevMan, ADDIS, and STATA software. To ensure consistency among our reviewers, the intra-class correlation coefficient was used.
Results Exactly 39 studies with 3433 participants were covered in this meta-analysis. The meta-analysis demonstrated that all acupuncture types were superior to sham acupuncture in terms of total nasal symptom score and rhinoconjunctivitis quality of life questionnaire. Moxibustion was recommended as the most effective intervention as it reduced nasal symptoms in 6 treatments. On the other hand, manual acupuncture plus conventional medicine was recommended as the most effective intervention in improving the quality of life in 9 treatments. Notably, moxibustion was recommended as the most effective intervention that changed the content of IgE in 9 treatments. Moreover, adverse events of these interventions were acceptable.
ConclusionOur findings revealed that all acupuncture methods are effective and safe for AR. Moreover, either moxibustion or manual acupuncture plus conventional medicine are potentially the most effective treatment strategies for AR. Based on these findings, it is evident that acupuncture therapy is not inferior to pharmacologic therapy. Therefore, for AR patients who are either unresponsive to conventional medicine or are intolerant to adverse events, acupuncture therapy should be administered. However, the quality of these included trials was mainly ranked as moderate quality, we recommend additional well-designed RCTs with larger sample sizes to validate these findings.

1.1.2. Liu 2016

Liu Jie, Hong Jue, Zhang Cui-hong, et al. Acupuncture for allergic rhinitis: a systematic review and meta analysis Journal of Acupuncture and Tuina Science. 2016;14(6):426. [191959].

Objective To analyze and review the clinical efficacy of acupuncture (including electroacupuncture) alone for allergic rhinitis (AR) and to compare its efficacy with antihistamines and Chinese patent medicine Bi Yan Kang Tablet.
Methods The search strategy, inclusion and exclusion criteria were made according to the principie of evidence-based medicine. We performed a systematic search on China National Knowledge lnfrastructure (CNKI), Wanfang Academic Journal Full-text Database (Wanfang), Chongqing vlP Database (CQVIP), Chinese Biomedical Literature Database (CBM), PubMed, Excerpta Medica Database (EMBASE), Web of Science, Cochrane Library, and Cochrane Central Register of Controlled Trials (CENTRAL) for randomized controlled trials (RCT5) of acupuncture for allergic rhinitis between January 1990 and December 2015. The quality was evaluated by Cochrane Handbook for Systematic Reviews of lnterventions Version 5.1, and the meta-analysis was conducted by RevMan 5.3 version.
Results Twenty eligible RCTS were included into the meta-analysis after selection. Compared with antihistamines, the meta-analysis showed RR=1.24>1, 95%Cl[1.15, 1.33], P<(0.00001, indicating that acupuncture achieved a better total effective rate for AR than antihistamines; MD=-O.93<(O, 95%Cl[-1.22, - 0.63], P<(O.00001, indicating that acupuncture is better than antihistamines in decreasing the total nasal symptom score (TNSS) in AR patients; and MD==1.46>0, 95%Cl[-lo.84, 13.75], P=0.82, indicating that there was no statistical difference between acupuncture and antihistamines in regulating immunoglobulin E (lgE) in AR patients. Compared with Bi Yan Kang Tablet, the meta-analysis has shown RR=1.50>1, 95%Cl[1.30, 1.73], P<(O.00001, indicating that acupuncture achieved a better total effective rate for AR than Chinese patent medicine Bi Yan Kang Tablet.
ConclusionAcupuncture alone can achieve a better total effective rate for AR than antihistamines and Bi Yan Kang Tablet. Lt is also better than antihistamines in improving clinical symptom scores; however, whether acupuncture is better than Bi Yan Kang Tablet needs further proof. As far as current data are concerned, there was no statistical difference between acupuncture and antihistamines in improving serum lgE; further study is neededi n this regard. The risk of bias due to absent randomization methods or blinding implementation decreased the evidence level of the overall conclusion.

1.1.3. Qu 2016 ☆☆

Qu Shu-Han, Liu Yun-Xia. [Systematic review and meta-analysis of the randomized controlled trial of acupuncture for allergic rhinitis]. World Journal of Integrated Traditional and Western Medicine. 2016;7:900-906. [187067].

Objectives To evaluate the efficacy and safety of acupuncture for allergic rhinitis (AR) with the systematic review of evidence - based medicine.
Methods The database of CNKI, VIP, Wanfang, Pubmed and Cochrane Library were retrieved. The relevant and unpublished conference paper and academic dissertation were traced. Additionally, the references of retrieved literatures and the reviews of paper were supplemented. The deadline time of retrieval was November 2015. The randomized controlled trials (RCTs)of AR were collected in terms of the treatments with simple acupuncture or combined therapy of acupuncture and relevant adjuvant treatment/ control positive medication (or sham - acupuncture/ blank control/ placebo). RevMan5. 2 was used for the combination of the literatures with low clinical heterogeneity for the Meta - anal-ysis. Otherwise, the qualitative analysis was followed.
Results The effective rate in the simple acupuncture group was apparently higher than that in the western medicine group, that in the combined group of acupuncture and electroacupuncture was apparently higher than that in the western medicine group, and that in the simple acupuncture group was apparently higher than that in the sham - acupuncture group. The results of quantitative analysis showed: for the improvement of the effective rate of AR symptoms treated with basic ther-apy of acupuncture (or combined with other adjuvant treatment), the results were better than or equal to those in the control group. Limitation: due to the language issue, the literatures of Chinese and English version were included, which possibly induced selection bias. The results for the positive results were easily published, which could induce the potential publication bias of the included literatures.
Conclusions Acupuncture or the adjuvant therapy with electric stimulation combined has a certain efficacy on the symptoms of AR and displays the long - term efficacy. The safety of acupuncture has not been evaluated definitely at present yet.

1.1.4. Feng 2015 ☆☆

Feng S, Han M, Fan Y, Yang G, Liao Z, Liao W, Li H. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. Am J Rhinol Allergy. 2015;29(1):57-62. [177791]

Background Because acupuncture may modulate the immune system, it has been proposed as a useful treatment for patients with allergic rhinitis (AR). Here, we assessed the evidence for the clinical efficacy of acupuncture for the management of AR patients by performing a systematic review and meta-analysis of the published literatures.
MethodsBy searching PubMed, EMBASE, the Cochrane clinical trials database, and the China National Knowledge Infrastructure from 1980 through July 11, 2013, we collected and analyzed the randomized controlled trials (RCTs) of acupuncture for the treatment of AR patients to assess its efficacy and safety.
ResultsThirteen full papers that met our inclusion criteria were included, and a total of 2365 participants, including 1126 as treatment group and 1239 as control group, were enrolled. Compared with control group, acupuncture treatment group exerted a significant reduction in nasal symptom scores (weighted mean difference [WMD]: -4.42, 95% confidence interval [CI]: -8.42 to -0.43, p = 0.03), medication scores (WMD: 1.39, 95% CI: -2.18 to -0.61, p = .0005), and serum IgE (WMD: -75.00, 95% CI: -91.17 to -58.83, p < 0.00001). Data relating to Rhinitis Quality of Life Questionnaire (RQLQ) and 36-Item Short-Form (SF-36) component score in included studies were analyzed, which ultimately point to the efficacy of acupuncture treatment in improving quality of life in AR patients. No fatal events were reported in any of the included studies, and no serious systemic reaction, which needed treatment in the hospital, was related to the acupuncture treatment.
ConclusionOur meta-analysis suggests that that acupuncture could be a safe and valid treatment option for AR patients.

1.1.5. Li 2013 ☆

Li Xinrong, Zhang Qinxiu, Liu Min, Zhang Fubing, Wang Xiaopei. [Acupuncture for allergic rhinitis: a systematic review]. Journal of Liaoning University of Traditional Chinese Medicine. 2013;3:51-57. [187009].

Objectives To examine the efficacy and safety of acupuncture in the treatment of allergic rhinitis.
Methods A search was performed to gather randomized controlled trials about acupuncture treatment for allergic rhinitis in PubMed, ASP (Academic Source Premier)of ECSCO, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang database, and the database of Chinese Clinical Trial Registry as well as the database of scientific dissertation and conference papers. The randomized controlled trials which involved acupuncture treatment for allergic rhinitis and met the inclusion criteria were selected. Then assessment was conducted for the qualities of these trials, interventions, outcome measurements and results.
Results There were 8 clinical trials selected. A Meta-analysis was performed on a total of 204 patients involved in 3 papers in which nasal symptoms scores had been used as the primary outcome measurements. The SMD (standardized mean difference)was-0. 642, 95%CI (confidence interval)was-0. 942~-0. 360. The rhombus located on the leftward of the null line in the forest plots. This indicated that acupuncture could decrease nasal symptoms and be benefit to relieve allergic rhinitis. Because of clinical differences and various outcome measures, other data was not combined in Meta-analysis, and a descriptive analysis was performed. The result indicated a positive effect of acupuncture in improving the efficiency of allergic rhinitis. And two trials reported acupuncture was benefit for improvement of serum special IgE. Only one trial referred to eosinophils.
Conclusions It suggested that acupuncture is an effective treatment for allergic rhinitis and there is no severe side effect. But there is still a need for more randomized controlled clinical trials in which correlated laboratory indexes should be reported besides symptoms. Moreover, trials with high quality to assure high internal validity are expected to be conducted in China.

1.1.6. Xiao 2009 ☆

Xiao L, Li B, Du Yh, Xiong J, Gao X.. [Systematic Evaluation of the Randomized Controlled Trials about Acupuncture and Moxibustion Treatment of Allergic Rhinitis]. Chinese Acupuncture and Moxibustion. 2009;29(6):512-6. [154891].

Objectives To evaluate the clinical effect and safety of acupuncture and moxibustion treatment for allergic rhinitis and to analyze the present situation of clinical researches.
Methods A search in PubMed, Cochrane Library, Chinese Biology Medicine (CBM) disk, and China National Knowledge Infrastructure (CNKI) databases was performed to gather the randomized controlled trials about acupuncture and moxibustion treatment for allergic rhinitis, identify additional clinical trials met the inclusion criteria and measure their qualities by using Cochrane Reviewers' Handbook 5.0. Statistical analysis was carried out by RevMan 4.2.8.
Results A meta-analysis was performed on a total of 1076 patients involved in 12 papers which met the inclusion criteria. There were significant differences in both cure rate (Incorporate RR = 1.86, 95% CI 1.51, 2.29, Z = 5.82, P < 0.00001) and marked improvement rate (Incorporate RR = 1.58, 95% CI 1.32, 1.89, Z = 4.94, P < 0.00001) between acupuncture and moxibustion treatment and the routine medicine treatment for allergic rhinitis.
Conclusions Acupuncture and moxibustion to treat allergic rhinitis is effective and safe and may have certain advantage over the routine medicine treatment. However, as for the low quality of partial inclusion literatures, no definite conclusion can be obtained as yet and it still waits for higher quality researches to further prove the dominance of acupuncture and moxibustion treatment for allergic rhinitis.

1.1.7. Zhao 2009 ☆

Zhao Minghui, Huang Xiaodong, Xiong Jun, Qi Yingzhou Li Sheng. [Systematic evaluation on therapeutic effect of acupuncture for allergic rhinitis]. Chinese Journal of Otorhinolaryngology in Integrative Medicine. 2009;6:. [186960].

Objectives To assess the therapeutic effect of acupuncture on allergic rhinitis.
Methods A systematic review including all the relevant randomized controlled trials (RCT or CCT) of acupuncture for treatment of allergic rhinitis were performed using the method recommended by the cochrane collaboration. The data were statistically analyzed with a special analysis software RevMan 4. 2.
Results Eleven experiments including randomized controlled trials (RCT or CCT) met the enrolled criteria. The number of included persons ranged from 70 to 420 and totaled 1733. All of the trials were of lower methodological quality. Meta-analysis of enrolled 11 trials showed that the acupuncture group had a better therapeutic effect on allergic rhinitis than the control group (RR 1. 23, 95%CI (1. 14, 1. 33) Z =5. 15, P<0. 00001).
Conclusions Although the acupuncture group had a better therapeutic effect on allergic rhinitis than the control group and without toxic side effects, but the included literatures on the study were not high quality studies. Therefore, it is necessary to perform more multi-central randomized controlled trials in good internal validity and high quality in future.

1.1.8. Lee 2009 ☆

Lee Ms, Pittler Mh, Shin Bc, Kim Ji, Ernst E. Acupuncture for allergic rhinitis: a systematic review. Ann Allergy Asthma Immunol. 2009;102(4):269-79. [153032].

Objective To systematically evaluate the effectiveness of acupuncture for treating or preventing allergic rhinitis (AR).
Methods Data Sources: We retrieved data from 17 electronic databases, nonelectronic searches of conference proceedings, our own files of articles, and bibliographies of located articles. Study selection: All randomized clinical trials (RCTs) of acupuncture for AR were considered for inclusion if they included placebo controls or were controlled against a comparator intervention.
ResultsOne hundred fifteen possibly relevant studies were identified and 12 RCTs met our inclusion criteria. The methodologic quality of the individual trials was variable. Our review includes 7 trials of high quality that met standards of methodologic rigor. All RCTs tested the effectiveness of acupuncture on AR symptoms and none on its curative value. Three RCTs failed to show superiority of acupuncture for treating or preventing symptoms for seasonal AR compared with placebo acupuncture. For perennial AR, 1 study reported favorable effects of acupuncture on a rhinitis symptoms score and 1 found positive results for a nasal symptoms score compared with placebo acupuncture (n = 152; standard mean difference, 0.45; 95% confidence interval, 0.13-0.78; P = .006; heterogeneity: chi2 = 0.45, P = .50, I2 = 0%). Two RCTs compared acupuncture with oral pharmacologic medications. Their results were in favor of acupuncture.
Conclusions The evidence for the effectiveness of acupuncture for the symptomatic treatment or prevention of AR is mixed. The results for seasonal AR failed to show specific effects of acupuncture. For perennial AR, results provide suggestive evidence of the effectiveness of acupuncture.

1.1.9. Roberts 2008

Roberts J, Huissoon A, Dretzke J, Wang D, Hyde C. A systematic review of the clinical effectiveness of acupuncture for allergic rhinitis. Bmc Complement Altern Med. 2008;8(1):13. [148803].

BackgroundAllergies cause a considerable burden to both sufferers and the National Health Service. There is growing interest in acupuncture as a treatment for a range of conditions. Since acupuncture may modulate the immune system it could be a useful treatment for allergic rhinitis (AR) sufferers. We therefore assessed the evidence for the clinical effectiveness of acupuncture in patients with AR by performing a systematic review of the literature.
MethodsSearches (to 2007) were conducted in all major databases for randomised controlled trials (RCTs) evaluating the clinical effectiveness of acupuncture in the treatment of AR. No limits were placed on language. Studies were included if they compared acupuncture to a sham or inactive acupuncture treatment (placebo) with or without standard care. Meta-analysis was performed where feasible.
ResultsSeven relevant RCTs were included after screening and application of inclusion and exclusion criteria. The trials were generally of poor quality as assessed by a modified Jadad scale, with the exception of two studies which scored highly. A wide variety of outcomes was measured but most assessed symptom severity on a visual analogue scale. A meta-analysis failed to show any summary benefits of acupuncture treatment for symptom severity scores or serum IgE measures which could not have been accounted for by chance alone. Acupuncture was not associated with any additional adverse events in the trials.
ConclusionThere is currently insufficient evidence to support or refute the use of acupuncture in patients with AR. A large well conducted RCT, which overcomes identified methodological problems in the existing RCTs, would be required to resolve this question.

1.1.10. Passalacqua 2006 Ø

Passalacqua G, Bousquet Pj, Carlsen Kh, Kemp J, Lockey Rf, Niggemann B, Pawankar R, Price D, Bousquet J. Aria Update: I-Systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol. 2006;117(5):1054-62. [141267]

Background Complementary-alternative medicines are extensively used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking.
Methods To provide evidence-based recommendations, the literature was searched by using MedLine and the Cochrane Library to March 2005 (Key words: Asthma [OR] Rhinitis, [AND] Complementary [OR] Alternative Medicine, [OR] Herbal, [OR] Acupuncture, [OR] Homeopathy, [OR] Alternative Treatment). Randomized trials, preferably double-blind and published in English, were selected. The articles were evaluated by a panel of experts. Quality of reporting was assessed by using the scale validated by Jadad. The methodology of clinical trials with complementary-alternative medicine was frequently inadequate.
Results Meta-analyses provided no clear evidence for the efficacy of acupuncture in rhinitis and asthma. Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed. A limited number of studies of herbal remedies showed some efficacy in rhinitis and asthma, but the studies were too few to make recommendations. There are also unresolved safety concerns.
Conclusions Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.

1.2. Special Acupuncture Techniques

1.2.1. Comparison of acupuncture techniques

1.2.2. Moxas

1.2.2.1. Yuan 2020 (Thunder Fire Moxibustion)

Yuan T, Xiong J, Yang J, Wang X, Jiang Y, Zhou X, Liao K, Xu L. The Effectiveness and Safety of Thunder Fire Moxibustion for Treating Allergic Rhinitis: A PRISMA Compliant Systematic Review and Meta-Analysis. vid Based Complement Alternat Med. 2020. [212552]. doi

BackgroundAllergic rhinitis (AR) is a noninfectious inflammatory disease caused by allergic individuals exposed to allergens. Western medicine therapy for treating AR causes obvious adverse events, while thunder fire moxibustion (TFM) is known as a safe and effective treatment for AR. Therefore, we conducted this meta-analysis to evaluate the effectiveness and safety of TFM for treating AR.
MethodsPubMed, Web of Science, Embase, the Cochrane Library, CNKI, WanFang, VIP, and CBM from inception to April 5, 2020, were searched without any language restriction. Reviewers identified studies, extracted data, and assessed the quality, independently. The primary outcomes were the total effective rate and the TNSS. The secondary outcomes included TNNSS, RQLQ, VAS, serum IgE, IgA, or IgG level, and adverse events. Randomized controlled trials (RCTs) were collected; methodological quality was evaluated using the Cochrane risk of bias assessment tool (RoB), and the level of evidence was rated using the GRADE approach. Meta-analysis was performed using the RevMan5.3.0 software.
Results A total of 18 RCTs were included, including 1600 patients. The results of this meta-analysis showed a statistically significant effect in a total effective rate of T = TFM (RR = 1.07; 95% CI [1.03, 1.12]; P = 0.45; I 2 = 0%) and T = TFM + other treatments (RR = 1.18; 95% CI [1.11, 1.25]; P = 0.03; I 2 = 53%). In addition, TFM intervention also showed significant difference in total symptom score (T = TFM + other treatments) (MD = -1.42; 95% CI [-1.55, -1.29]; P = 0.03; I 2 = 60%) in patients with AR.
Conclusion Existing evidence shows that TFM is safe and effective for AR. Due to the universal low quality of the eligible trials and low evidence level, we should draw our conclusions with caution. Therefore, clinical researchers should carry out more large-sample, multicentre, high-quality randomized controlled clinical trials in the future to verify the clinical efficacy of TFM in treating AR.

1.2.3. Acupoint herbal patching

1.2.3.1. Zhou 2015

Zhou F, Yan LJ, Yang GY, Liu JP. Acupoint herbal patching for allergic rhinitis:a systematic review and meta-analysis of randomised controlled trials. Clin Otolaryngol. 2015; 40(6):551-68. [159435].

Objective To evaluate the effectiveness and safety of AHP in treating allergic rhinitis.
Methods We searched seven electronic databases for RCTs from inception until August 2014. Two authors selected studies, extracted data and evaluated risk of bias independently. The Cochrane risk of bias tool was applied to assess the methodological quality of the included trials and RevMan 5.2 software was utilised to perform data analysis.
Results Twenty RCTs involving 2438 participants were included. Most of them were evaluated as high risk of bias. AHP significantly decreased the recurrence rate at six months compared with western medicine (RR 0.52; 95% CI 0.42 to 0.64), and similar effect was found for AHP plus western medicine versus western medicine (RR 0.53; 95% CI 0.44 to 0.65). AHP appeared to be more effective than placebo in improving total clinical symptoms and signs after treatment and at 6 months, and in improving quality of life at less than 3 months and over 3 months. No severe adverse effects were found in the AHP groups.
Conclusion AHP alone or combined with western medicine appears to be more effective than placebo or western medicine respectively. AHP seems to be a safe treatment. However, the findings should be interpreted with caution. Further large-scale, rigorously designed trials are warranted to confirm the findings .
1.2.3.2. Wen 2015 (in summer)

Wen CYZ, Liu YF, Zhou L, Zhang HX, Tu SH. A Systematic and Narrative Review of Acupuncture Point Application Therapies in the Treatment of Allergic Rhinitis and Asthma during Dog Days. Evidence-Based Complement Alternat Med. 2015. ID 846851, [184039].

Introduction Acupuncture point application therapies, including San-Fu-Tie and San-Fu-Jiu, have been widely employed to treat diseases with attacks in winter during dog days in China. The therapies combine Chinese herbal medicine and acupuncture points with the nature. However, the previous studies were reported to be unsystematic and incomplete.
Methods To develop a more comprehensive understanding of the effects of acupuncture point application therapies on allergic rhinitis and asthma, a systematic review of the literature up to 2015 was conducted.
Results After filtering, eighteen randomized controlled trials (RCTs) involving 1,785 subjects were included. This systematic and narrative review shows that acupuncture point application therapies have been extensively applied in the treatment of allergic rhinitis and asthma with advantages of favorable treatment effect, convenient operation, receiving patients’ good acceptability and compliance, and few side effects. Meanwhile, the study elaborated the operating process of San-Fu-Tie and San-Fu-Jiu in detail.
Conclusion The review may provide a reference for clinical application in future. However, the efficacy, safety, and mechanisms of San-Fu-Tie and San-Fu-Jiu in treating the above diseases need to be validated by more well-designed and fully powered RCTs in a larger population.

1.2.4. Catgut Embedding

1.2.4.1. Li 2014 ☆

Li XR, Zhang QX, Liu M, Chen Q, Liu Y, Zhang FB, Deng J, Zhong ZD. Catgut implantation at acupoints for allergic rhinitis: a systematic review. Chin J Integr Med. 2014;20(3):235-40. [171643]

ObjectiveTo assess the effectiveness and the possible adverse effects of catgut implantation at acupoints for allergic rhinitis (AR).
Methods This systematic review was carried out in accordance with the Cochrane Handbook version 5.1.0 and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Extensive literature searches were conducted in PubMed, Excerpta Medical Databases, the Cochrane Library, the China National Infrastructure, Wanfang Chinese Digital Periodical and Conference Database, and the Weipu Chinese Science and Technique Journals Database. The Chinese Clinical Trial Registry Center was also searched for ongoing trials up to September 2012. Randomized controlled trials (RCTs)or quasi-RCTs were included. Risk of bias assessment was performed using the Cochrane tool for assessing risk of bias.
ResultsFive RCTs with 285 participants were found from 49 relevant studies, but there was just one RCT which met the inclusion criteria for this review. The study showed that treatment of catgut implantation at acupoints could lead to a better alleviation of the signs and symptoms of AR than the crude herb moxibustion. No adverse events were reported in this study.
ConclusionsBecause of the methodological shortcoming and the risk of bias of the included trial, catgut implantation was proved with only limited evidence for the treatment of AR. Robust RCTs with high quality and larger sample size in this field are hoped to be carried out in the future.

1.2.5. Auricular Acupuncture

1.2.5.1. Zhang 2010 (acupression)

Zhang Cs, Yang Aw, Zhang Al, Fu Wb, Thien Fu, Lewith G, Xue Cc. Ear-acupressure for allergic rhinitis: a systematic review. Clin Otolaryngol. 2010;35(1):6-12. [155500].

BackgroundAllergic rhinitis affects 10-40% of the population globally with a substantial health and economic impact on the community.
ObjectiveTo assess the effectiveness and safety of ear-acupuncture or ear-acupressure for the treatment of allergic rhinitis by reviewing randomised controlled trials and quasi-randomised controlled trials.
Methods Type of review: This review followed the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions.Search strategy. A total of 21 electronic English and Chinese databases were searched from their respective inceptions to April 2008. Key words used in the search included the combination of ear, auricular, acupuncture, acupressure, acupoint, allergic, allergy, rhinitis, hayfever, randomised clinical trial and their synonyms. Evaluation method: The methodological quality was assessed using Jadad's scale. The effect size analysis was performed to explore the difference between interventional groups.
ResultsNinety-two research papers were identified and seven of them referring to five studies met the inclusion criteria. All included studies involved ear-acupressure treatment. These studies mentioned randomisation, but no details were given. None of the five studies used blinding or intention-to-treat analysis. Ear-acupressure was more effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term effect, but it was more effective than anti-histamine for long-term effect.
ConclusionsThe benefit of ear-acupressure for symptomatic relief of allergic rhinitis is unknown due to the poor quality of included studies.

1.2.6. Sphenopalatine Ganglion Acupoint

1.2.6.1. Fu 2019 ☆

Fu Q, Zhang L , Liu Y , Li X , Yang Y , Dai M , Zhang Q. Effectiveness of Acupuncturing at the Sphenopalatine Ganglion Acupoint Alone for Treatment of Allergic Rhinitis: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med. 2019. [197230].

Aims To evaluate the efficiency of acupuncturing at the sphenopalatine ganglion acupoint alone for treatment of allergic rhinitis.
DesignA total of ten online databases were searched to find studies published up to Jan. 2018. Primary outcome measures include the TNSS, the RQLQ score, the VAS score, total effective rate, score for signs and symptoms, and the improvement of disease classification. Study quality of each included article was evaluated by the Cochrane Collaboration risk of bias tool. A meta-analysis was conducted based on the Cochrane systematic review method by using RevMan 5.3 software. Interventions: Acupuncturing SGA alone was the only therapy in experimental group. Interventions in control groups includes sham acupuncture, acupuncturing other regular acupoints, and western medicine. Specific techniques included manual acupuncture and electroacupuncture only. Primary Outcomes: They include TNSS, RQLQ, VAS score, total effective rate, the improvement of disease classification.
ResultsTen studies of eight articles involving 1004 participants were included. Result of meta-analysis showed that acupuncturing sphenopalatine ganglion acupoints alone was more effective than control groups. However, several adverse effects were reported.
Conclusion These findings show that acupuncturing the sphenopalatine ganglion acupoint alone has a potential role in alleviating nasal symptoms, improving quality of life for patients, and the effectiveness of acupuncture in the treatment of allergic rhinitis, suggesting it as a considerable therapy for allergic rhinitis. However, more studies are needed to execute a subgroup analysis of various variables and to evaluate the publication bias of the study.
1.2.6.2. Chen 2016 ☆☆

Chen Lihe, Zhang Lu, Mao Wenhong, Shen Jianwu, Li Bo, Xu Zhixian, Guo Mengmeng, Wang Kejian, Zhang Lijuan, Xu Feng. [Evaluation on allergic rhinitis treated by sphenopalatine ganglion stimulation with acupuncture: a systematic review]. International Journal of TCM. 2016;38(3):254-60. [154940].

Objectives The advantages of the treating allergic rhinitis (AR) by sphenopalatine ganglion stimulation with acupuncture were evaluated.
Methods Databases including CBMDisk, CNKI, WanFang, VIP, Cochrane Library, PubMed, ProQuest, ChiCTR, ISRCTN, ClinicalTrials.gov and CENTRAL were searched from the beginning of database established to Jan 2015. All issues from Jan 2004 to Jan 2015 published on journals Chinese Acupuncture & Moxibustion, Shanghai Journal of Acupuncture and Moxibustion, Acupuncture Research, Journal of Clinical Acupuncture and Moxibustion, Chinese Journal of Integrated Traditional and Western Medicine and Chinese Journal of Otorhinolaryngology in Integrative Medicine were searched by hand at meantime. All data were extracted based on the inclusive and exclusive criteria which was pre-designed, the Revman5.3 was applied for meta-analysis, and the studies qualities were analyzed by grade score.
Results 118 articles were collected, 7 studies that involving 1 230 patients met the inclusive criteria. The result indicated that the sphenopalatine ganglion stimulation with acupuncture as the main treatment of AR showed the better total response rate compared to conventional drugs, the OR (95% CI) was 3.22(1.81 - 5.75); however the change of total symptom score had no statistical significant difference, the MD (95% CI) was 0.69 (-0.56 - 1.93), the change of IgE had no statistical significant difference,the SMD (95% CI) was -0.07 (-0.97 - 0.83).
Conclusions The main treatment on AR by sphenopalatine ganglion stimulation with acupuncture may has better efficacy than western medicine. But due to the methodological biases existed in most studies, future high-quality RCTs were needed to be included into Meta-analysis to test today’s study conclusion.

2. Overviews of Systematic Reviews

2.1. Zhang 2020

Zhang J, Zhang Y, Huang X, Lan K, Hu L, Chen Y, Yu H. Different Acupuncture Therapies for Allergic Rhinitis: Overview of Systematic Reviews and Network Meta-Analysis. Evid Based Complement Alternat Med. 2020. [208853]. doi

Objective To evaluate the quality of methodologies used in previous systematic reviews (SRs) and compare efficacy of different acupuncture therapies for allergic rhinitis.
MethodsSeven electronic databases were searched for systematic reviews (SRs) performed on different acupuncture therapies for allergic rhinitis from inception to 15 November 2019. The AMSTAR2 instrument was employed to assess the methodological quality of included SRs. Eligible randomized controlled trials (RCTs) were selected from the included systematic reviews. We also included recent RCTs published by 15 November 2019. Cochrane risk of bias tool was utilized to determine risk of bias of the included RCTs. Pairwise meta-analyses were performed using the random-effects model. Network meta-analysis of the included RCTs was carried out using frequentist framework.
Results We identified 2 SRs with low quality and 18 SRs with very low quality, both of which contained 33 eligible RCTs (n = 3769). Most of these studies had unclear risk of bias. On the basis of ranking probability, NMA analysis showed that acupuncture at the sphenopalatine ganglion acupoint (OR: 1.31, 95% CI 1.07 to 1.61) had the highest probability of improving global allergic rhinitis symptoms, followed by San-Fu-Tie (OR: 1.17, 95% CI 1.08 to 1.27), manual acupuncture (OR:1.15, 95% CI 1.07 to 1.24) compared with conventional western medicine treatment. Moreover, direct comparison of the follow-up period showed that the clinical outcomes of acupuncture and related therapies at three-month (OR:1.34, 95% CI 1.17 to 1.55), six-month (OR: 1.31, 95% CI 1.10 to 1.57), and twelve-month (OR: 1.30, 95%CI 1.11 to 1.53) follow-up were better than those of traditional western medicine.
ConclusionThese results indicate that for patients with allergic rhinitis who are unresponsive to conventional western medicine or cannot tolerate the side effects, acupuncture at the sphenopalatine ganglion acupoint is an effective alternative therapy. Further studies are advocated to deeply explore methodological quality of SRs by incorporating high-quality RCTs.

2.2. Zhou 2020 ☆

Zhou Jun. [Revaluation of Acupuncture for Allergic Rhinitis by AMSTAR and GRADE System: An Overview of Systematic Reviews and Meta-analyses]. Chinese Journal of Integrated Traditional and Western Medicine. 2020. [212958].

ObjectiveTo evaluate the methodological quality and outcomes of the systematic reviews(SRs) of acupuncture and moxibustion for allergic rhinitis(AR).
Methods Electronic retrieving The Cochrane Library, Medline(OvidSP), Embase(OvidSP), CNKI, CBM, VIP and WF databases to screen out the SRs/Meta-analyses that met the inclusion criteria, the retrieval time of each database was from inception to August 31st 2018. The AMSTAR scale was used to evaluate the methodological quality of the included studies, and the GRADE system was utilized to grade the outcome indicators of the included studies.
Results A total of 17 systematic reviews/Meta-analyses were included, with AMSTAR scores ranging from 9 to 22, among which 14 were of moderate quality and 3 were of high quality. Most results of studies showed that in the treatment of AR, acupuncture and moxibustion was superior to conventional drugs in response effect, improving nasal symptoms and other aspects.
Conclusions At present, available evidence suggested that systematic reviews/meta-analyses of acupuncture and moxibustion for AR had moderate methodological quality. The quality of evidence for most outcome indicators was low, and there was a small amount of moderate-quality evidence supported that acupuncture and moxibustion could effectively improved the symptoms and signs of AR.

3. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

3.1. American Academy of Allergy, Asthma, and Immunology (AAAAI, USA) American College of Allergy, Asthma, and Immunology (ACAAI, USA) 2020 Ø

Dykewicz MS, Wallace DV, Amrol DJ, Baroody FM, Bernstein JA, Craig TJ, et al. Rhinitis 2020: A practice parameter update. J Allergy Clin Immunol. 2020;146(4):721-67. [214667]. doi

Recommendation : We cannot make a recommendation for or against the use of acupuncture for the treatment of AR. Strength of recommendation: not applicable; Certainty of evidence: very low.

3.2. Société Française ORL et de Chirurgie de la Face et du Cou (SFORL, France) 2020 Ø

Crampette L, J. Michel J. Recommandation SFORL : Prise en charge diagnostique et thérapeutique des Rhinites Allergiques par l’ORL. Société Française ORL et de Chirurgie de la Face et du Cou. 2020. [182785]. URL

[L'acupuncture est abordée, sans recommandation formulée].

3.3. Chinese Society of Allergy (China) 2018 ⊕

Cheng L, Chen J, Fu Q, He S, Li H, Liu Z, Tan G, Tao Z, Wang D, Wen W, Xu R, Xu Y, Yang Q, Zhang C, Zhang G, Zhang R, Zhang Y, et al. Chinese Society of Allergy Guidelines for Diagnosis and Treatment of Allergic Rhinitis. Allergy Asthma Immunol Res. 2018;10(4):300-53. [183054]. doi: doi

To sum up, an increasing body of evidence indicates that acupuncture is a safe treatment option, and most of the acupunc¬ture methods employed can improve AR symptoms of nasal itching, sneezing, rhinorrhea, and especially nasal stuffiness. Acupuncture at either general or special acupoints needs to be continued over several weeks to observe significant beneficial and stable effects on symptom improvement.

3.4. International Consensus Statement on Allergy and Rhinology (ICAR) 2018 ⊕

Wise SK, Lin SY, Toskala E, Orlandi RR, Akdis CA, Alt JA, Azar A, Baroody FM, Bachert C, Canonica GW, Chacko T, Cingi C, et al. International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis. Int Forum Allergy Rhinol. 2018;8(2):108-352. [183055]. doi

In patients who wish to avoid medications, acupuncture may be suggested as possible therapeutic adjunct.

3.5. Malaysia Health Technology Assessment Section (MaHTAS, Malaysia) 2016 Ø

Malaysia Health Technology Assessment Section (MaHTAS). Management of rhinosinusitis in adolescents and adults. Ministry of Health (MoH). 2016:51P. [172206]. URL

There is insufficient evidence to support the use of complementary alternative medicines in rhinosinusitis (acupuncture).

3.6. European Academy of Allergy and Clinical Immunology 2015 (EAACI, Europe) ⊕

Nematian-Semani M, Eichel A, Mosges R. Conservative non-drug treatment for allergic rhinitis In Akdis CA,Hellings PW, Agache I, eds. Global Atlas of AllergicRhinitis and Chronic Rhinosinusitis. European Academy of Allergy and Clinical Immunology. 2015. 442p. [185647].

Nonpharmacological treatment options for allergic rhinitis gainpopularity and may be applied alone or complementarily. Apart from isotonic and hypertonic nasal sprays, which arealready widely used, alternative methods, such as thermalwater applications, endonasal phototherapy or acupunctureare available and have been investigated in clinical trials. Although the exact mechanism of action is not yet fullyunderstood, clinical evidence assigns similar efficacy tononpharmacological treatments compared to traditional agentswith hardly any side effects (p 202).
Acupuncture can be recommended as adjunct therapy for AR. Other therapies have shown some clinical promise (p 228).

3.7. American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF, USA) 2015 ⊕

Seidman MD, Gurgel RK, Lin SY, Schwartz SR, Baroody FM, Bonner JR, Dawson DE, Dykewicz MS. ClinicaL practice guideline: allergic rhinitis executive summary. Otolaryngol Head Neck Surg. 2015;152(2):197-206. [178221].

Statement 13. Acupuncture. Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with allergic rhinitis who are interested in nonpharmacologic therapy (option). based on randomized controlled trials with limitations, observational studies with consistent effects, and a preponderance of benefit over harm.

3.8. Michigan Medicine, University of Michigan (USA) 2013 Ø

Allergic Rhinitis. Guidelines for Clinical Care Ambulatory. Michigan medicine University of Michigan. 2013:17P. [198404].

Some studies have shown some decrease in symptoms with acupuncture and probiotics; however medication therapy has not been able to be decreased. More studies need to be done in this area.

3.9. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 Ø

Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63 Suppl 86:8-160. [212225]. doi

| Considering the RCTs, there is no clear evidence of the efficacy of acupuncture in rhinitis and asthma.|