15. Acupuncture and Chinese Medicine for Allergic Rhinitis

Compiled by Joseph Brady MSTCM, L.Ac., Dipl. OM

Contact: taichiproj@earthlink.net | joe.brady@faculty.ccmu.edu

1529 York Street, Denver, CO 80206

Acknowledgements

Special thanks to Cheryl Wheeler and Jacqui Shumway for their invaluable assistance in verifying and formatting references. Each review is a snapshot of the best available evidence at the time of publication and will be updated regularly to reflect new research.

Author’s Note on AI Use

Artificial intelligence was used to assist with formatting, reference management, and language refinement in the preparation of this manuscript. All content, including interpretation of data and conclusions, was reviewed and verified by the author to ensure accuracy and scholarly integrity.

Allergic rhinitis (AR) is a chronic inflammatory disorder affecting over 500 million individuals globally, characterized by nasal congestion, sneezing, rhinorrhea, and ocular symptoms. While antihistamines and corticosteroids remain standard therapy, limitations such as incomplete symptom control, drug dependence, and side effects have increased interest in complementary and integrative health (CIH) approaches, particularly acupuncture and Chinese herbal medicine (CHM).

Acupuncture

Efficacy:

High-quality evidence supports acupuncture as an effective adjunctive treatment for AR. A meta-analysis of 13 RCTs (Feng et al., 2015) found significant improvements in Total Nasal Symptom Score (TNSS), quality of life (QOL), and reductions in IgE levels compared to control. The landmark ACUSAR RCT (Brinkhaus et al., 2013) demonstrated reduced antihistamine use, improved symptom scores, and cost-effectiveness.

GRADE Assessment: Moderate quality for QOL and symptom improvement, low for IgE reduction, due to heterogeneity and blinding limitations.

Mechanisms:

Acupuncture exerts effects via immune regulation (balancing Th1/Th2 responses, modulating IgE), neural modulation (altered neuropeptide release), anti-inflammatory activity (reduced cytokine expression), and potential gut microbiota modulation (Bu & Lou, 2025).

Comparisons with Conventional Therapy:

Acupuncture performs comparably to antihistamines (e.g., cetirizine, loratadine) with fewer side effects (Qin et al., 2022). Intranasal acupuncture shows additional promise in improving nasal airflow and symptom burden (Li et al., 2023).

Chinese Herbal Medicine

Efficacy:

Evidence for CHM is promising but more heterogeneous. A meta-analysis by Zhang et al. (2018) found significant QOL improvement over placebo or conventional medicine, though nasal symptom results were inconsistent. Another review (Zhang, Qi, & Wang, 2023) of oral CHM reported a 97.09% effective rate and reduced recurrence (24.46%) compared to controls. Pediatric-specific meta-analysis (Journal of International Medical Research, 2018) showed higher efficacy rates (OR = 3.32, 95% CI [2.32–4.76]) and significant IgE reductions (MD = −46.01).

Classical Formulas:

• Yu Ping Feng San (Jade Screen Powder): Strengthens defensive qi, high efficacy and low recurrence (Zhang et al., 2023).
• Yi Qi Tong Qiao Pill: Network pharmacology shows modulation of IL-4, IFN-γ, TNF-α, and IL-13 pathways.
• Cang-Er-Zi-San: Demonstrates safety and efficacy in pediatric AR (Zeng et al., 2024).

Safety:

Generally well-tolerated when prescribed by qualified practitioners, but adverse event reporting is often incomplete. Caution is required with certain herbs (e.g., Xanthii Fructus) due to potential toxicity if improperly processed (Li et al., 2023).

Integrated Approaches

Combining acupuncture with CHM or conventional therapy may yield synergistic benefits—reducing medication dependence, enhancing symptom control, and improving QOL (Chan & Ng, 2020). Evidence supports integration under careful monitoring to avoid herb–drug interactions.

Research Gaps and Future Directions

• Standardization: Need for uniform CHM formulations, dosing, and duration to improve reproducibility.
• Safety Data: Rigorous adverse event reporting required.
• Mechanistic Studies: Further exploration of NF-κB, TLR4/MyD88, IL-33/ST2, PI3K/AKT, and Nrf2 pathways.
• High-Quality Trials: Large, multicenter, double-blind RCTs with standardized outcome measures.

Conclusion

Acupuncture has moderate-quality evidence for improving AR symptoms and QOL, with biological plausibility supported by mechanistic studies. CHM shows promising but less consistent results due to methodological variability. Integration of acupuncture, CHM, and conventional therapy appears beneficial and safe when appropriately managed. Future research should prioritize high-quality trial design, standardized protocols, and robust safety reporting to strengthen the evidence base.

Key References (GRADE-Ordered, APA 7th)

High Quality

Brinkhaus, B., Ortiz, M., Witt, C. M., Roll, S., Linde, K., Pfab, F., … & Willich, S. N. (2013). Acupuncture in seasonal allergic rhinitis: A randomized controlled trial. Annals of Internal Medicine, 158(4), 225–234. https://doi.org/10.7326/0003-4819-158-4-201302190-00002

Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W., … & Liu, J. (2015). Acupuncture for the treatment of allergic rhinitis: A systematic review and meta-analysis. American Journal of Rhinology & Allergy, 29(1), 57–62. https://doi.org/10.2500/ajra.2015.29.4116

Qin, W., Huang, Y., Zhang, X., Luo, Z., Yang, X., & Sun, W. (2022). Acupuncture for allergic rhinitis: A systematic review and meta-analysis. European Journal of Medical Research, 27, 58. https://doi.org/10.1186/s40001-022-00682-3

Zhang, X., Lan, F., Zhang, Y., & Zhang, L. (2018). Chinese herbal medicine to treat allergic rhinitis: Evidence from a meta-analysis. Allergy, Asthma & Immunology Research, 10(1), 34–42. https://doi.org/10.4168/aair.2018.10.1.34

Zeng, Q., Zhang, H., Zhu, H., Zhang, Z., & Li, Y. (2024). Evaluation of the efficacy and safety of Chinese medicine Cang-Er-Zi-San in the treatment of allergic rhinitis in children: A meta-analysis and systematic review. Medicine, 103(34), e33345. https://doi.org/10.1097/MD.0000000000033345

Moderate Quality

Li, X., Zhang, W., Ma, X., Zhao, Y., & Zhang, H. (2024). Intranasal acupuncture for allergic rhinitis: A systematic review and meta-analysis. Medicine, 103(12), e100123. https://doi.org/10.1097/MD.0000000000040305

Zhang, Y., Qi, L., & Wang, R. (2023). Meta-analysis: Reducing the recurrence rate of allergic rhinitis through oral administration of traditional Chinese medicine. European Review for Medical and Pharmacological Sciences, 27(17), 7924–7934. https://doi.org/10.26355/eurrev_202309_33551

Chan, H., & Ng, T. B. (2020). Traditional Chinese Medicine and allergic diseases. Current Allergy and Asthma Reports, 20(9), 67. https://doi.org/10.1007/s11882-020-00959-9

Low Quality / Emerging Evidence

Bu, F., & Lou, Z. (2025). A review of recent progress in the mechanisms and effectiveness of acupuncture for treating allergic rhinitis. International Journal of General Medicine. https://doi.org/10.2147/IJGM.S501158

Li, Y., Zhao, W., Zhang, X., & Chen, J. (2023). Multiorgan failure caused by Chinese herbal medicine Xanthii Fructus poisoning: A case report. BMC Complementary Medicine and Therapies, 23, 14. https://doi.org/10.1186/s12906-023-04105-6