Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
About the research:
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
A scholarly search on “allergies” + “acupuncture” reveals over 3,400 papers, and narrowing to Randomised Controlled Trials (RCT’s) reveals over 369 results (Google Scholar). This shows that acupuncture is being used traditionally and currently in this area, and that it has been recognised there is a need to research it a scientific manner.
A large, randomised controlled research study in Germany (Brinkhaus et al 2017; n=1445) showed that up to 15 sessions of acupuncture given in addition to routine care increased both disease specific, and health related quality of life, when compared to the group who received routine care alone.
In an animal model study, acupuncture treatment was shown to inhibit swelling of the ears and ear weight in mice with oxazolone-induced skin allergic dermatitis, compared to non-acupuncture treatment (Okumura et al, 2002), and lower levels of inflammatory markers (serum and ear tissue cytokines) were also lowered in the acupuncture group.
A forthcoming systematic review protocol has been published with the aim of evaluating the efficacy and safety of acupuncture in the treatment of atopic dermatitis (protocol: Lee et al, 2019). This is another growing research area, of 451 RCT’s ever published on this, 180 have been carried out since 2017.
More generally, for chronic pruritus, a condition of chronic itching that can be caused by different disease states and which adversely affects quality of life, a systematic review is awaited, the protocol having been published in the BMJ Open recently (protocol: Zhang et al, 2020).
A systematic review (Jiao et al, 2020) looked at 8 RCT’s (n=434), and despite some methodological limitations were able to conclude acupuncture may decrease itch sensitivity and improve the global symptoms of atopic eczema.
The results of a small (n=10), randomised controlled trial (Pfab et al, 2011), suggested acupuncture reduced itch intensity and the expression of certain immune factors (basophils) in patients with atopic eczema. The acupuncture group showed less CD63 positive basophils (allergy markers in the body) and rated mean itch intensity significantly lower than did the control group after exposure to allergens (house dust mite and timothy grass pollen). Pfab et al 2010 (n=30) had also found that after an allergen stimulus (house mite or grass pollen skin prick), the size of the wheal and flare at the skin site were smaller in the group receiving preventative acupuncture than in the control (no acupuncture) and placebo (non-specific acupuncture points used) groups, suggesting that the actual points used are also relevant and not just the overall action of needling. Mean itch ratings were also lower once again in the true acupuncture group.
Allergic Rhinitis (Hayfever):
The British Acupuncture Council has a Research digest where they examined some recent studies on Allergic Rhinitis, with an overall trend that acupuncture was found beneficial, comparing favourably with antihistamine use. A review of the literature (Taw et al, 2015) found that high-quality RCTs demonstrated efficacy and effectiveness of acupuncture in this condition, and also was beneficial in terms of quality of life measures, the researchers also stated that further high quality studies are desirable in this area due to some methodological limits on study designs.
Feng et al, (2015) carried out a systematic review and meta-analysis of acupuncture in allergic rhinitis, entailing 13 papers (N=2365 in total); the researchers stated this was a safe intervention which gave improvement in the Rhinitis Quality of Life Questionnaire (RQLQ) scores of the participants in the acupuncture groups.
Two studies have also established cost effectiveness of acupuncture in allergic rhinitis; Kim et al, (2012) carried out a systematic review of 17 RCTs using the quality-adjusted life years (QALYs) measure the NHS uses, demonstrating that as well as offering benefits, these were value for money where acupuncture was used. Witt and Brinkhaus (2010) reached a similar conclusion but more tentatively, calling for further studies to establish this.
McDonald et al (2013) reviewed the pathophysiology of allergic rhinitis and the acupuncture research body in this area. Acupuncture has been shown to improve clinical outcomes in patients with allergic rhinitis by modulating immune response and reducing inflammation. Per the review of RCTs, acupuncture may down-regulate Th2 and proinflammatory cytokines, proinflammatory neuropeptides (such as SP, CGRP and VIP) and neurotrophins (such as NGF and BDNF) in allergic rhinitis. Acupuncture may also inhibit histamine-induced itch and TRPV1 signalling, which mediate some of the symptoms of allergic rhinitis.
Possible mechanisms of action in allergy:
A review article (Kavoussi & Ross, 2007) suggests that the anti-inflammatory actions that have been demonstrated to be brought about by acupuncture may be mediated via activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines. The researchers concluded that “The use of acupuncture as an adjunct therapy to conventional medical treatment for a number of chronic inflammatory and autoimmune diseases seems plausible and should be validated by confirming its cholinergicity”. Other studies (Zijlstra et al, 2003) have revealed that acupuncture some of the pain modulating and anti-inflammatory effects exhibited in acupuncture may be due to the fact that it has been shown to stimulate certain substances in the body which act as vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) and further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states.
Acupuncture can activate mast cells at acupoints, which release histamine, serotonin, adenosine, and other mediators that modulate nerve transmission and inflammation (Li et al, 2022)
Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:
- Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
- Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
- Acupuncture may contribute to analgesia by stimulating the release of β-endorphin, which binds to opioid receptors and inhibits pain signals.
- Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.
CSR and ERP are blood tests related to the functioning of the immune system, that can measure and monitor inflammation in the body. They are relevant to conditions such as Rheumatoid Arthritis, and other immune and inflammatory conditions. Per a review by Feng at al, (2023) electroacupuncture (EA) plus medication had a significant effect in lowering both ESR and CRP levels in patients with RA compared with medication alone. These results suggest that EA may have an anti-inflammatory effect and improve the immune status of patients with RA.
In an animal study, Sun et al, (2023) were able to show that electroacupuncture worked by blocking a pathway in the synovium called TLR2/4, that activates immune response and inflammation. The researchers therefore suggested the anti-inflammatory and analgesic effects of EA were related to the inhibition of TLR2/4 signalling on synovial fibroblasts and macrophages.
Wei et al, 2015 investigated the effect of acupuncture on airway inflammation and immune responses in mice with experimental asthma. Acupuncture was effective in reducing airway hyperresponsiveness (AHR); lung inflammation; mucus secretion; and inflammatory markers including Th17 cytokines and NF-κB pathway, in the asthma model. Additionally, acupuncture increased the number and function of Treg cells – a type of white blood cell that can suppress inflammation and prevent autoimmunity. The article suggests that acupuncture may be a useful complementary therapy for asthma patients due to anti-inflammatory and immune modulation effects.
Liu et al (2014) investigated the anti-inflammatory effect of electroacupuncture (EA) in a rat tissue chamber model of inflammation. The study found that EA inhibited the p65 protein from moving to the cell nucleus to activate inflammatory genes. EA also increased the expression of IκBα, which binds to NF-κB and preventing it from entering the nucleus to activate inflammatory genes. These interfere with the IκB/NF-κB pathway that regulates inflammation, indicating one of the mechanisms of acupuncture in modulating immune / inflammatory response.
Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines. They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis. They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.
Per MacDonald et al (2015), acupuncture may:
- reduce inflammation and nasal congestion by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins
- modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation
- influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors
- activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine
Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function). Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response, we are able to tell you in the decades of experience we personally have at the clinic of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, which is why the research data do not tell the whole story and if you want to find out more specific information in how this could relate to your own individual situation, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
British Acupuncture Council Research Digest – Allergic Rhinitis (approx halfway down the document)
BAcC Asthma Factsheet
British Acupuncture Council (BAcC) evidence based factsheet about Allergic Rhinitis including specific research, trials and mechanisms of action for acupuncture in this condition
Brinkhaus, B., Roll, S., Jena, S., Icke, K., Adam, D., Binting, S., Lotz, F., Willich, S.N. and Witt, C.M., 2017. Acupuncture in patients with allergic asthma: a randomized pragmatic trial. The Journal of Alternative and Complementary Medicine, 23(4), pp.268-277.
Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W. and Li, H., 2015. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), pp.57-62.
Feng, Y., Zhang, R., Zhao, Z., He, Y., Pang, X., Wang, D. and Sun, Z., 2023. Efficacy and safety of electroacupuncture combined with medication for rheumatoid arthritis: A systematic review and meta-analysis. Heliyon.
Jiao, R., Yang, Z., Wang, Y., Zhou, J., Zeng, Y. and Liu, Z., 2020. The effectiveness and safety of acupuncture for patients with atopic eczema: a systematic review and meta-analysis. Acupuncture in Medicine, 38(1), pp.3-14.
Kavoussi B, Ross BE. The neuroimmune basis of anti-inflammatory acupuncture. Integr Cancer Ther 2007; 6: 251-7.
Kim, S.Y., Lee, H., Chae, Y., Park, H.J. and Lee, H., 2012. A systematic review of cost-effectiveness analyses alongside randomised controlled trials of acupuncture. Acupuncture in Medicine, 30(4), pp.273-285.
Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8
Li, Y., Yu, Y., Liu, Y. and Yao, W., 2022. Mast cells and acupuncture analgesia. Cells, 11(5), p.860.
Lee, H.C. and Park, S.Y., 2019. Preliminary comparison of the efficacy and safety of needle-embedding therapy with acupuncture for atopic dermatitis patients. Evidence-Based Complementary and Alternative Medicine, 2019.
Liu, F., Fang, J., Shao, X., Liang, Y., Wu, Y. and Jin, Y., 2014. Electroacupuncture exerts an anti-inflammatory effect in a rat tissue chamber model of inflammation via suppression of NF-κB activation. Acupuncture in Medicine, 32(4), pp.340-345.
McDonald, J.L., Cripps, A.W., Smith, P.K., Smith, C.A., Xue, C.C. and Golianu, B., 2013. The anti-inflammatory effects of acupuncture and their relevance to allergic rhinitis: a narrative review and proposed model. Evidence-Based Complementary and Alternative Medicine, 2013.
McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.
Okumura M et al. Effects of acupuncture on an oxazolone induced skin allergic dermatitis animal model using male ICR mice. Journal of the Showa Medical Association 2002; 62: 229-36.
Pfab, F., Huss‐Marp, J., Gatti, A., Fuqin, J., Athanasiadis, G.I., Irnich, D., Raap, U., Schober, W., Behrendt, H., Ring, J. and Darsow, U., 2010. Influence of acupuncture on type I hypersensitivity itch and the wheal and flare response in adults with atopic eczema–a blinded, randomized, placebo‐controlled, crossover trial. Allergy, 65(7), pp.903-910.
Pfab, F., Athanasiadis, G.I., Huss-Marp, J., Fuqin, J., Heuser, B., Cifuentes, L., Brockow, K., Schober, W., Konstantinow, A., Irnich, D. and Behrendt, H., 2011. Effect of acupuncture on allergen-induced basophil activation in patients with atopic eczema: a pilot trial. The Journal of Alternative and Complementary Medicine, 17(4), pp.309-314.
Sun, S.Y., Yan, Q.Q., Qiao, L.N., Shi, Y.N., Tan, L.H. and Yang, Y.S., 2023. Electroacupuncture Alleviates Pain Responses and Inflammation in Collagen-Induced Arthritis Rats via Suppressing the TLR2/4-MyD88-NF-κB Signaling Pathway. Evidence-Based Complementary and Alternative Medicine, 2023
Taw, M.B., Reddy, W.D., Omole, F.S. and Seidman, M.D., 2015. Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), pp.216-220.
Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.
Wei, Y., Dong, M., Zhang, H., Lv, Y., Liu, J., Wei, K., Luo, Q., Sun, J., Liu, F., Xu, F. and Dong, J., 2015. Acupuncture attenuated inflammation and inhibited Th17 and Treg activity in experimental asthma. Evidence-based complementary and alternative medicine, 2015.
Witt, C.M. and Brinkhaus, B., 2010. Efficacy, effectiveness and cost-effectiveness of acupuncture for allergic rhinitis—an overview about previous and ongoing studies. Autonomic Neuroscience, 157(1-2), pp.42-45.
Zhang, L., Deng, Y., Yao, J., Xiao, X., Yu, S., Shi, Y., Zheng, H., Zheng, Q., Zhou, S., Cao, W. and Liu, Y., 2020. Acupuncture for patients with chronic pruritus: protocol of a systematic review and meta-analysis. BMJ open, 10(8), p.e034784.
Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J. and Klein, J., 2003. Anti-inflammatory actions of acupuncture. Mediators of inflammation, 12(2), pp.59-69.