Acupuncture alleviates allergic rhinitis and is more effective than a corticosteroid nasal spray and oral antihistamine. Lianyungang Hospital of Traditional Chinese Medicine (Kangda College of Nanjing Medical University) researchers conducted a clinical investigation and determined that acupuncture produces superior long-term patient outcomes. Allergic rhinitis (often referred to as hay fever) is an inflammatory reaction affecting the nose after exposure to airborne allergens including pollen, dander, dust, and mold or after consumption of foods that trigger an allergenic response.

Common symptoms include a runny nose, nasal and eustachian tube congestion, itching, dysosmia, watery eyes, coughing, sore throat, headaches, fatigue, irritability, and swelling or dark circles under the eyes. The researchers determined that drug therapy produces significant relief; however, acupuncture is more effective over the long-term.

The study compared warm needle acupuncture with fluticasone nasal spray (a steriod) and oral desloratadine (an antihistamine) in 100 patients with allergic rhinitis. The inclusion criteria included a biomedical diagnosis of allergic rhinitis and a Traditional Chinese Medicine (TCM) diagnosis of lung qi deficiency and cold. Initially, the total effective rate in the acupuncture group was 90% and was 78% in the drug therapy group. At the follow-up assessment (30 days after treatment) the total effective rates were 84% and 72% respectively. The researchers conclude that acupuncture provides significant and lasting relief from allergic rhinitis and is worthy of further study.

Following randomization, the acupuncture group was comprised of 29 male and 21 female participants, ages 22–55 years (mean age 38.7 years), with a disease duration of 0.50–12 years (mean duration 4.93 years). The drug therapy group was comprised of 28 male and 22 female participants, ages 19–58 years (mean age 36.52 years), with a disease duration of 0.50–12 years (mean duration 4.55 years). There were no statistically significant differences in baseline characteristics between the two groups.

Biomedical diagnostic criteria included at least two of the following symptoms: sneezing, clear nasal discharge, nasal congestion, or nasal itching. Symptoms were required to occur daily and continue for at least one hour, possibly accompanied by itchy eyes and tearing. Clinical signs included: visibly pale mucosa, nasal edema, watery secretions, and a positive skin prick test for at least one allergen or positive serum IgE (immunoglobulin E) test.

TCM diagnostic criteria included symptoms of lung qi deficiency-cold syndrome. This encompassed items such as a history or family history of allergies and at least two of the following primary symptoms: nasal congestion, nasal itching, frequent sneezing, clear nasal discharge. Secondary symptoms included: pale complexion, aversion to wind and cold, spontaneous perspiration, shortness of breath, dislike of speaking, a pale tongue with a thin white coating, and a weak pulse.

In addition to the above diagnostic criteria, patients were required to meet the following inclusion criteria: ages 18–60 years, no other anti-allergy or related treatment within the previous two weeks, voluntary participation and informed consent, and the ability to cooperate with the proposed treatment protocol.

Exclusion criteria included: TCM syndrome differentiation other than lung qi deficiency-cold, respiratory tract infection or acute secondary sinusitis within the previous two weeks, chronic sinusitis, having undergone nasal surgery, asthma or other respiratory diseases, tuberculosis, hepatitis, hepatic or renal dysfunction, serious cardiovascular, cerebrovascular, or hemopoietic diseases, psychiatric disorders, having received targeted immunotherapy or hormone therapy within the previous year, having used antihistamines, corticosteroids, TCM, acupuncture, or other treatments for allergic rhinitis within the previous two weeks, pregnancy or planned pregnancy, lactation, smoking >10 cigarettes for >10 years, or inability to comply with treatment and follow-up visits.

 

Medicine
The drug therapy group was treated with fluticasone propionate nasal spray (50 mcg/spray) and desloratadine (8.8 mg tablets). The nasal spray was used in both nostrils (twice daily) during the acute phase, and reduced to once daily when the condition stabilized. Desloratadine was taken once daily during the acute phase for a maximum of one week. Treatment lasted a total of four weeks.

The acupuncture group did not receive medications. The acupuncture group received acupuncture at the following acupoints while resting in a supine position:

  • Baihui (GV20)
  • Yintang (MHN3)
  • Yingxiang (LI20)
  • Hegu (LI4)
  • Guanyuan (CV4)
  • Zusanli (ST36)
  • Taichong (LV3)

Baihui, Guanyuan, and Zusanli were treated with warm needle acupuncture. Acupuncture needles (0.35 x 50 mm) were inserted into the points and deqi was elicited using a twisting-rotating reinforcing technique. A 40 mm piece of moxa (cut from an 18 x 200 mm roll) was attached to the needle handle and ignited. A cover was placed underneath the needle to protect the skin from falling ash.

The remaining acupoints were inserted using 0.30 x 40 mm needles. Baihui and Yintang were angled toward the root of the nose and were stimulated to elicit a needle sensation spreading toward the nose. Hegu and Taichong were stimulated using a balanced reinforcing-reducing method. Needles were manipulated twice while in situ. Treatments were alternated with the following acupoints, administered with patients in a prone position:

  • Fengchi (GB20)
  • Dazhui (GV14)
  • Jiaji (MBW35: 3 upper thoracic region points)
  • Ganshu (BL18)
  • Pishu (BL20)
  • Shenshu (Bl23)

Warm needle acupuncture was applied to the Jiaji points, Pishu, and Shenshu (according to the procedure listed above). Fengchi was angled toward the nose, while the remaining acupoints were stimulated with a balanced reinforcing-reducing method. Needles were manipulated twice while in situ. Treatment was administered daily, alternating between supine and prone protocols, for four days each week. Four weeks of treatment constituted one course of care.

 

Results
Outcome measures for the study included a VAS (visual analog scale), clinical sign and symptom scores, and the total effective rates for each group. A self-rated VAS of 0–10 was used to assess each patient’s subjective view of their overall condition, with higher scores indicating more severe symptoms. Mean pre-treatment VAS scores were 7.32 in the drug therapy group and 7.06 in the acupuncture group. Following treatment, these scores fell to 3.96 and 3.18 respectively. At the 30-day follow-up assessment, these scores reduced further to 3.22 in the drug therapy group and 1.72 in the acupuncture group, indicating significantly greater improvements in the acupuncture group.

Physical signs were scored as follows: closing of the inferior nasal conchae and septum making it impossible to view the nasal cavity or the appearance of nasal polyps (3 points), closing of the inferior nasal conchae and septum but with a small space (2 points), mild edema of the inferior nasal conchae but the nasal cavity is visible (1 point), nasal cavity is normal (0 points). Mean pre-treatment physical sign scores were 2.04 in the drug therapy group and 2.2 in the acupuncture group. Following treatment, these scores fell to 1.26 and 0.88 respectively. At the 30-day follow-up assessment, these scores increased slightly to 1.28 in the drug therapy group and reduced to 0.78 in the acupuncture group, indicating significantly greater improvements in the acupuncture group.

Symptoms including sneezing, nasal discharge, nasal congestion, nasal itching, red and itchy eyes, eye irritation, and tearing were scored from 0–3, with 0 indicating and absence of symptoms, 1 mild symptoms, 2 moderate symptoms, and 3 severe symptoms. Mean pre-treatment symptom scores were 12.28 in the drug therapy group and 11.7 in the acupuncture group. Following treatment, these scores fell to 8.36 and 6.48 respectively. At the 30-day follow-up assessment, these scores reduced further to 7.36 in the drug therapy group and 4.18 in the acupuncture group, indicating significantly greater improvements in the acupuncture group.

The total effective rates for each group were calculated both directly after treatment and at the 30-day follow-up assessment. For patients displaying clear improvements of ≥66%, the treatment was classified as markedly effective. For patients displaying improvements of ≥26%, the treatment was classified as effective. For patients displaying no improvements, the treatment was classified as ineffective.

Immediately after treatment, the drug therapy group was comprised of 3 markedly effective, 36 effective, and 11 ineffective cases, yielding a total effective rate of 78%. The acupuncture group was comprised of 8 markedly effective, 37 effective, and 5 ineffective cases, yielding a total effective rate of 90%. At the 30-day follow-up assessment, the drug therapy group was comprised of 5 markedly effective, 31 effective, and 14 ineffective cases, yielding a total effective rate of 72%. The acupuncture group was comprised of 12 markedly effective, 30 effective, and 8 ineffective cases, yielding a total effective rate of 84%. The total effective rates were significantly higher in the acupuncture group at both assessments.

The results of this study indicate that acupuncture is an effective treatment for allergic rhinitis that outperforms a specific corticosteroid and antihistamine therapeutic regimen. Importantly, acupuncture provided ongoing relief for at least 30 days after completion of treatment.

 

Reference:
Sun Dunpo, Yao Wenping, Ma Xiaomin, Xu Jinsheng, Jiang Mingxiao (2019) “Clinical Study of Needling-Warming Moxibustion with Big Moxa Stick in the Treatment of Allergic Rhinitis of Deficiency-Cold of Lung-Qi” JCAM Vol.35(9) pp.141-145.

 

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