Acupuncture for Allergic Rhinitis: Role Remains Questionable

Norra MacReady

February 18, 2013

Acupuncture may improve the symptoms of seasonal allergic rhinitis (SAR), but "the clinical significance of the findings is uncertain," the authors of a new study write in an article published online February 18 in the Annals of Internal Medicine.

Lead author Benno Brinkhaus, MD, from the Charité-University Medical Center and German Red Cross Hospital Westend, Berlin, Germany, and colleagues studied 422 people randomly assigned to receive treatment with real acupuncture plus rescue medication (RM) with cetirizine if needed (n = 212), sham acupuncture plus RM if needed (n = 102), or RM alone (n = 108). Patients in the first 2 groups had 12 sessions of real or sham acupuncture over the course of 8 weeks. They were assessed at week 7 or 8 of treatment, with a follow-up assessment at weeks 15 to 16.

Patients receiving RM alone underwent 12 sessions of real acupuncture starting on week 8 of the study to ensure that all of the groups received some form of acupuncture. They, too, had a follow-up assessment at week 16. All patients were reevaluated 7 to 8 weeks into allergy season the next year.

The participants completed the Rhinitis Quality of Life Questionnaire (RQLQ). Medication need was determined using an RM score, with 1 point given for every cetirizine dose of 10 mg/day, 2 points for 20 mg/day, and 3 points for any use of steroids. Patients also filled out a visual analogue scale describing symptom severity and the German version of the Short Form-36 to assess health-related quality of life.

Table. Primary Endpoints: Mean Change From Baseline (95% Confidence Interval [CI])

  Acupuncture Sham Acupuncture Rescue Medication P value, real vs sham acupuncture P value, acupuncture vs medication
RQLQ*          
 Year 1, weeks 7 to 8 −1 (−1.3 to −0.7) −0.5 (−0.8 to −.2) −0.3 (−0.6 to −0.02) <.0001 <.001
 Follow-up, year 1 −1.6 (−1.8 to −1.4) −1.5 (−1.7 to −1.2) −1.5 (−1.7 to −1.3) .25 .31
 Year 2, weeks 7 to 8 −0.8 (−1.1 to −0.5) −0.5 (−0.8 to −0.2) −0.8 (−1.2 to −0.5) .032 .95
RM score*          
 Year 1, weeks 7 to 8 −1.5 (−2.2 to −0.9) −0.4 (−1.1 to 0.3) −0.05 (−0.8 to 0.7) <.001 <.001
 Follow-up, year 1 −2.0 (−2.4 to −1.6) −1.6 (−2.0 to −1.1) −1.9 (−2.3 to −1.4) .035 .46
 Year 2, weeks 7 to 8 .3 (−0.5 to 1.2) 1.4 (0.4 to 2.3) 0.4 (−0.6 to 1.3) .018 .93

*Lower values indicate greater improvement.

At weeks 7 to 8, acupuncture was associated with significant improvements in RQLQ and a need for rescue medication, but "the CIs surrounding the estimates of improvement included values that were less than predefined thresholds for clinically important differences, so the clinical significance of the findings is uncertain," the authors write.

In an editorial, Remy Coeytaux, MD, PhD, from the Duke Clinical Research Institute, and Jongbae J. Park, DKM, PhD, LAc, from the University of North Carolina at Chapel Hill, praise the investigators for using "an acupuncture protocol that simulates actual clinical practice" and write that the study lends "compelling support to the effectiveness of real-world acupuncture for SAR."

However, "these improvements were minimal," William S. Silvers, MD, emphasized in an email. Dr. Silvers, past chairman of the Complementary and Alternative Medicine Committee of the American Academy of Asthma, Allergy, and Immunology, adds that "acupuncture itself has no role in SAR [treatment]."

He concludes, "One must always recognize the potential of the 'placebo effect' with any active intervention. The reservation is that acupuncture was a single intervention, and in traditional Chinese medicine, it may be used with herbal intervention." Emerging data suggest that certain Chinese herbal extracts may have anti-inflammatory properties in food allergy and asthma, and "therefore should be helpful in SAR."

The study was funded by a grant from the German Research Foundation. One of the authors is on the board of DAK Health Insurance. The other authors have disclosed no relevant financial relationships. Dr. Coeytaux is a board member of the Society for Acupuncture Research and sometimes receives travel expenses from them. Dr. Park receives grant money from the National Institutes of Health and the National Institute of Dental and Craniofacial Research, is a board member of the Society for Acupuncture Research, and holds stock or stock options in AcuPrime. Dr. Silvers has disclosed no relevant financial relationships.

Ann Intern Med. Published online February 18, 2013.

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