A recent randomized clinical trial shows that manual acupuncture significantly reduces nasal inflammation and allergic symptoms in patients with seasonal allergic rhinitis (SAR), while not altering Th1/Th2 immune balance. Seasonal allergic rhinitis is an IgE-mediated hypersensitivity reaction to airborne allergens such as pollen, causing nasal congestion, sneezing, rhinorrhea, and itching during specific times of the year.
The study, conducted by researchers at the University of Erlangen–Nuremberg, found that patients who received semi-standardized manual acupuncture experienced reductions in nasal levels of key pro-inflammatory cytokines, including IL-1β, IL-8, IP-10, MIP-1β, MCP-1, and eotaxin. These changes were not observed in patients receiving sham acupuncture or antihistamine treatment alone, indicating that the physiological effects were specific to real acupuncture treatment and not attributable to placebo or pharmacological intervention. [1]
The study enrolled a total of 29 SAR patients during active pollen season and divided them into three groups. Sixteen patients received real acupuncture in combination with oral cetirizine, six received sham acupuncture with cetirizine, and eight received cetirizine alone as a control group. All participants were blinded to the type of acupuncture administered. The treatment protocol lasted for eight weeks, with real acupuncture provided twice weekly for the first four weeks and once weekly for the remaining four weeks, totaling 12 sessions. [1]
The acupuncture protocol utilized stainless steel, single-use filiform needles with a gauge of 0.25 mm (34 gauge) and lengths between 25 and 30 mm. Needles were inserted to achieve a deqi (得气) sensation and were retained for 20 minutes per session. Manual stimulation, including lifting-thrusting and bidirectional rotation techniques, was applied every five minutes. Electrical stimulation was not used in this protocol. [1]
The core acupuncture points used in the real treatment group included LI4 (Hegu), LI11 (Quchi), LI20 (Yingxiang), and the extra point Yintang (Ex-HN3). These points were selected for every treatment session. Additional points were chosen based on each patient’s Chinese medicine pattern differentiation and included GB20 (Fengchi), LV3 (Taichong), ST36 (Zusanli), LU7 (Lieque), and SP6 (Sanyinjiao). On average, 15.7 ± 2.5 needles were used per session in the real acupuncture group, compared with approximately 10 needles in the sham group. [1]
In the sham group, needles were inserted superficially at non-acupuncture points, without attempting to elicit deqi. These sessions served as a control for the physical presence of needles without engaging traditional point locations or acupuncture-specific stimulation methods. [1]
Patients receiving real acupuncture showed a statistically significant decrease in nasal symptom scores by the eighth week. These improvements were not observed in either the sham acupuncture group or the medication-only group. Quantitatively, the nasal symptom index in the acupuncture group declined by approximately 30 to 40 percent from baseline, whereas scores in the control groups either remained unchanged or worsened slightly. [1]
Biochemical analyses revealed that real acupuncture led to a substantial reduction in the concentration of several key pro-inflammatory cytokines in nasal secretions. IL-1β levels dropped by approximately 25 percent, IL-8 by 30 percent, IP-10 by 20 percent, MIP-1β by 22 percent, MCP-1 by 18 percent, and eotaxin by 15 percent. These reductions were statistically significant and were not observed in the sham or medication-only groups. [1]
However, no significant changes were observed in Th1- or Th2-related cytokines such as IFN-γ, IL-4, IL-5, or IL-10, either in nasal secretions or plasma samples. This suggests that the mechanism of action for acupuncture in SAR may involve nonspecific local anti-inflammatory effects rather than modulation of allergen-specific T-helper cell activity. [1]
The authors propose that the anti-inflammatory effects observed may be mediated through neuromodulatory pathways, potentially involving cholinergic or sympathetic nervous system activity, which could suppress local immune mediator release. This hypothesis aligns with prior studies suggesting that acupuncture can modulate autonomic and neuroimmune function at the site of inflammation without directly altering systemic adaptive immune balance. [2] [3]
The results of this trial indicate that acupuncture can be effectively integrated into the treatment of seasonal allergic rhinitis using a repeatable and measurable clinical protocol. Licensed acupuncturists can replicate this approach by using 0.25 mm × 25–30 mm filiform needles, selecting the aforementioned acupoints, and ensuring proper manual stimulation to elicit and maintain de qi throughout the treatment session. Treatments are twice weekly for the first month, then weekly for the second month, for a total of 12 sessions. The clinical outcomes suggest that nasal symptom reduction is most likely when manual acupuncture is applied consistently and thoroughly over the course of pollen season, rather than as a one-time intervention. [1]
HealthCMi staff acupuncturists note that consistent acupuncture from year to year gradually reduces or eliminates SAR symptoms. Each consecutive allergy season is typically marked by fewer nasal symptoms and reduced inflammation.
The study reported no serious adverse events, and all participants tolerated the procedures well. The combination of acupuncture and cetirizine proved more effective than cetirizine alone, offering a potential pathway for reducing reliance on antihistamines during allergy season. [1]
Although the sample size was modest, and the study’s findings need replication in larger multicenter trials, this research provides strong mechanistic evidence that acupuncture can reduce nasal inflammation and improve quality of life in SAR patients through measurable reductions in pro-inflammatory chemokines. Licensed acupuncturists are advised to adopt standardized needle specifications and session frequencies, while monitoring patients’ symptom progression to ensure optimal outcomes.
This study adds to the growing body of literature supporting acupuncture’s role as a non-pharmacologic treatment for allergic rhinitis and offers a scientifically grounded, replicable protocol for clinical practice. [1]
Sources:
1. Gellrich, Donata, et al. “Acupuncture and its effect on cytokine and chemokine profiles in seasonal allergic rhinitis: a preliminary three-armed randomized controlled trial.” European Archives of Oto-Rhino-Laryngology 279 (2022).
2. Hong, G., et al. “Research progress on the new mechanism of acupuncture treatment for allergic rhinitis.” Journal of Alternative and Complementary Integrative Medicine 10, no. 6 (2024).
3. Yao, Q., et al. “Acupuncture modulation of inflammatory pathways and immune cells in allergic conditions.” International Journal of General Medicine (2024).
