The American Academy of Otolaryngology guideline below defines allergic rhinitis as an allergic inflammation of the lining of the nose after breathing in an allergen, with a runny nose, congestion, itching and sneezing, either seasonal, as in hay fever, or perennial, lasting all year. Two large German trials, a Korean trial and many smaller trials have tested acupuncture for both, and two guideline bodies in otolaryngology, the specialty of the ear, nose and throat, classify acupuncture as an option a clinician may offer. Both bodies note that it has rarely been compared directly with the standard medicines.
What the meta-analyses found
A 2022 meta-analysis by He and colleagues pooled 30 randomised trials with 4,413 participants and checked its pooled results with trial sequential analysis, a method that asks whether enough people have been studied to trust a result. Its findings in adults:
- Against no treatment, acupuncture improved nasal symptoms on the Total Nasal Symptom Score and quality of life on the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ).
- Against sham acupuncture, acupuncture improved the RQLQ nasal symptom subscale (mean difference −0.60, 95% CI −1.16 to −0.04; 489 people) and overall quality of life (−8.47, 95% CI −14.91 to −2.03; 248 people).
- Against the antihistamines cetirizine or loratadine, no clear difference.
Trial sequential analysis did not confirm any of these results, and most trials had serious performance and attrition bias, meaning participants knew their treatment or dropped out unevenly. The effect in children and adolescents was unclear for lack of data.
An earlier 2015 meta-analysis by Feng and colleagues at Shanghai Jiaotong University pooled 13 trials with 2,365 participants and found lower nasal symptom scores (weighted mean difference −4.42, 95% CI −8.42 to −0.43) and lower serum IgE, the antibody that drives allergic reactions, with acupuncture than in the control groups. No included study reported a fatal event or a serious systemic reaction related to acupuncture.
For children, a 2024 meta-analysis by Xiao and colleagues at Sichuan University pooled 13 trials with 1,186 participants. Acupuncture alone did not differ from medication (risk ratio 1.10, 95% CI 0.97 to 1.24), and trial sequential analysis showed the trials were too small to settle the comparison. Acupuncture added to medication did better than medication alone (risk ratio 1.29, 95% CI 1.17 to 1.42). IgE levels after treatment favoured medication, relapse was less frequent after acupuncture (risk ratio 0.40), and the authors rated the evidence as generally low quality.
Three large trials
| Trial | Who and what | Result |
|---|---|---|
| Brinkhaus and colleagues 2008, Germany | 981 people with allergic rhinitis randomised to up to 15 sessions over 3 months on top of routine care, or routine care alone; 4,256 more who declined randomisation had acupuncture and were followed alongside | RQLQ improved by 1.48 points with acupuncture and 0.50 without at 3 months, a difference of 0.98; improvements in both acupuncture groups were smaller at 6 months than at 3 |
| ACUSAR, Brinkhaus and colleagues 2013, Germany | 422 people with hay fever and IgE sensitisation to birch and grass pollen, treated by 46 physicians; 12 sessions over 8 weeks of acupuncture (212) or sham acupuncture (102), both with cetirizine as rescue medication, or rescue medication alone (108) | After 8 weeks RQLQ was 0.5 points better than with sham and 0.7 better than with medication alone, and rescue medication use was lower; no differences at 16 weeks; in the second year, small differences again favoured acupuncture over sham |
| Choi and colleagues 2013, Korea | 238 people with allergic rhinitis randomised to acupuncture (97), minimal sham needling at non-acupuncture points (94) or a waiting list (47), three times a week for 4 weeks | Total Nasal Symptom Score fell 1.03 points more than with sham and 2.49 more than on the waiting list; symptoms outside the nose improved against the waiting list but not against sham; both needling groups improved from baseline |
The ACUSAR authors concluded that acupuncture produced statistically significant improvements in disease-specific quality of life and antihistamine use after 8 weeks, but that the improvements may not be clinically significant. They noted that the trial was not powered to detect rare adverse events and that RQLQ and medication scores were low at baseline. The AAO-HNS guideline below treats an RQLQ change of 0.5 as clinically relevant. ACUSAR was a randomised trial with a sham arm; the 2008 trial compared acupuncture with routine care alone, so it cannot separate the needling from the attention and expectation that come with it. Sham acupuncture explains the difference.
What guidelines say
The American Academy of Otolaryngology–Head and Neck Surgery Foundation’s 2015 clinical practice guideline on allergic rhinitis, by Seidman and colleagues, states that clinicians may offer acupuncture, or refer to a clinician who can, for patients interested in non-drug therapy. Its profile of the statement:
- Strength: option, which the guideline uses where the evidence is suspect or where good studies show little clear advantage of one approach over another, leaving a substantial role for patient preference.
- Aggregate evidence: grade B, from randomised trials with limitations and observational studies with consistent effects.
- Confidence in the evidence: low, because the trials did not compare acupuncture with standard medical therapy and had methodological flaws.
- Benefit and harm: in equilibrium; the harms listed are repeated needle sticks, the cost and logistics of many sessions, and rare infections.
- Value judgements: panel members varied in their preconceived bias for or against acupuncture.
The International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis 2023, by Wise and colleagues, rates the aggregate evidence for acupuncture as grade A, from 4 level 1 studies and 1 level 2 study, and also sets the policy level at option: acupuncture can be suggested as a possible adjunct for patients interested in avoiding medications. It lists the harms as minor needle reactions such as skin irritation, bruising, itching, numbness, fainting and headache, the risk of electroacupuncture interfering with pacemakers and other implanted devices, and caution in pregnancy, and rates the cost as moderate to high. It names the scarcity of head-to-head trials against standard medicines as the main gap. Clinical guidelines sets out other bodies’ positions.
What the reviews could not settle
Few trials compare acupuncture head to head with standard medicines, and the 2022 meta-analysis found no clear difference against antihistamines. In both German trials the effects shrank after treatment stopped, and none of the reviews reports how long a benefit lasts. The pooled results against sham did not survive trial sequential analysis. Evidence in children rests on trials that compared acupuncture with medication, without sham controls, at generally low quality.
AcuiQ’s allergic rhinitis, seasonal allergic rhinitis and perennial allergic rhinitis pages list the protocols individual studies prescribed, each with its citation.