Is manual acupuncture effective in treating seasonal allergic rhinitis?
Date of publication: February 2013
Design
Randomized controlled trial (RCT).
Participants
422 patients aged 16 to 45 with seasonal allergic rhinitis diagnosed by an allergologist and had IgE sensitization to birch and grass pollen (mean age: 33 years, male%: 40.5%).
Intervention
Manual acupuncture was provided in 12 sessions over 8 weeks, with needle retention time between 20 and 30 minutes in each session. Needles were manually stimulated at least once in each session. Acupuncture was administered by conventionally trained physicians.
For rescue medication, all patients could receive up to 2 doses of cetirizine per day. If seasonal allergic rhinitis symptoms were not adequately controlled with cetirizine, patients could be treated with an oral corticosteroid. The use of other antiallergic mediation was prohibited.
Comparator
Comparison 1: Manual acupuncture plus rescue medication (cetirizine) versus sham acupuncture plus rescue medication (cetirizine);
Comparison 2: Manual acupuncture plus rescue medication (cetirizine) versus rescue medication (cetirizine) alone.
Major Outcomes
Outcome 1: Change in symptoms as measured by the Rhinitis Quality of Life Questionnaire (RQLQ) score after 7 to 8 weeks. Higher scores indicated lower quality of life;
Outcome 2: Change in need for medication as measured by the Rescue Medication (RMS) score after 7 to 8 weeks. Higher scores indicated greater use of rescue medications.
Settings
This trial was conducted in 6 hospital clinics and 32 private outpatient clinics.
Comparison    Manual acupuncture plus rescue medication (cetirizine) versus sham acupuncture plus rescue medication (cetirizine)
Main Results
Compared to sham acupuncture plus rescue medication (cetirizine), manual acupuncture plus rescue medication (cetirizine) showed significant improvement in RQLQ score (mean difference (MD): 0.5, 97.5% CI: 0.2 to 0.8) and RMS score (MD: 1.1, 97.5% CI: 0.4 to 1.9) after 7 to 8 weeks.
Comparison 1: Manual acupuncture plus rescue medication (cetirizine) versus sham acupuncture plus rescue medication (cetirizine) among seasonal allergic rhinitis patients
Outcomes (units) No. of studies (Total no. of participants) Mean change/ No. of participants Heterogeneity test (I2) MD (97.5% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (422) Not reported / 212 Not reported / 102 Not applicable as there is only 1 study 0.5 (0.2 to 0.8) <0.001 Moderate
2 (NA) 1 (422) Not reported / 212 Not reported / 102 Not applicable as there is only 1 study 1.1 (0.4 to 1.9) <0.001 Moderate
Keys: MD = mean difference, CI = confidence interval.
Comparison    Manual acupuncture plus rescue medication (cetirizine) versus rescue medication alone
Main Results
Compared to rescue medication alone, manual acupuncture plus rescue medication (cetirizine) showed significant improvement in RQLQ score (mean difference (MD): 0.7, 97.5% CI: 0.4 to 1.0) and RMS score (MD: 1.5, 97.5% CI: 0.8 to 2.2) after 7 to 8 weeks.
Comparison 2: Manual acupuncture plus rescue medication (cetirizine) versus rescue medication alone among seasonal allergic rhinitis patients
Outcomes (units) No. of studies (Total no. of participants) Mean change / No. of participants Heterogeneity test (I2) MD (97.5% CI) p value Overall quality of evidence*
Intervention Comparator
1 (NA) 1 (422) Not reported / 212 Not reported / 108 Not applicable as there is only 1 study 0.7 (0.4 to 1.0) <0.001 Moderate
2 (NA) 1 (422) Not reported / 212 Not reported / 108 Not applicable as there is only 1 study 1.5 (0.8 to 2.2) <0.001 Moderate
Keys: MD = mean difference, CI = confidence interval.
Comparison    Manual acupuncture plus rescue medication (cetirizine) versus sham acupuncture plus rescue medication (cetirizine)
Main Results
Compared to sham acupuncture plus rescue medication (cetirizine), manual acupuncture plus rescue medication (cetirizine) showed significant improvement in RQLQ score (mean difference (MD): 0.5, 97.5% CI: 0.2 to 0.8) and RMS score (MD: 1.1, 97.5% CI: 0.4 to 1.9) after 7 to 8 weeks.
Comparison 1: Manual acupuncture plus rescue medication (cetirizine) versus sham acupuncture plus rescue medication (cetirizine) among seasonal allergic rhinitis patients
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total no. of participants) 1 (422) 1 (422)
Mean change/ No. of participants Intervention Not reported / 212 Not reported / 212
Comparator Not reported / 102 Not reported / 102
MD (97.5% CI) 0.5 (0.2 to 0.8) 1.1 (0.4 to 1.9)
p value <0.001 <0.001
Overall quality of evidence* Moderate Moderate
Keys: MD = mean difference, CI = confidence interval.
Comparison    Manual acupuncture plus rescue medication (cetirizine) versus rescue medication alone
Main Results
Compared to rescue medication alone, manual acupuncture plus rescue medication (cetirizine) showed significant improvement in RQLQ score (mean difference (MD): 0.7, 97.5% CI: 0.4 to 1.0) and RMS score (MD: 1.5, 97.5% CI: 0.8 to 2.2) after 7 to 8 weeks.
Comparison 2: Manual acupuncture plus rescue medication (cetirizine) versus rescue medication alone among seasonal allergic rhinitis patients
Outcomes (units) 1 (NA) 2 (NA)
No. of studies (Total no. of participants) 1 (422) 1 (422)
Mean change / No. of participants Intervention Not reported / 212 Not reported / 212
Comparator Not reported / 108 Not reported / 108
MD (97.5% CI) 0.7 (0.4 to 1.0) 1.5 (0.8 to 2.2)
p value <0.001 <0.001
Overall quality of evidence* Moderate Moderate
Keys: MD = mean difference, CI = confidence interval.
Conclusion
Benefits
Compared with sham acupuncture and with rescue medication alone, manual acupuncture showed significant improvements in disease-specific quality of life and rescue medication use among seasonal allergic rhinitis patients after 8 weeks of treatment. However, between-group differences in change were generally smaller and no longer statistically significant at 16 weeks. For all outcomes, the overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
Harms
There were 157 adverse events among 133 patients (39% in the manual acupuncture group, 37% in the sham acupuncture group, and 23 % in the rescue medication group). Most were hematoma or inconsequential bleeding or pain. Five serious adverse events occurred among 5 patients (adnexal tumor (n=1) and appendicitis (n=1) among patients in the acupuncture group and Bartholin gland abscess (n=1), tibia and fibula fracture (n=1), and vertebral fracture (n=1) among patients in the rescue medication group). However, none is found to be associated with acupuncture use.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/23420231
The synopsis is based on the following article:
Brinkhaus B, Ortiz M, Witt CM, Roll S, Linde K, Pfab F, et al. Acupuncture in patients with seasonal allergic rhinitis: a randomized trial. Ann Intern Med. 2013 Feb 19;158(4):225-34.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.