Acupuncture for Allergies

26 Avr Acupuncture for Allergies

It’s not longer a secret that people resort to acupuncture for allergies . Allergic rhinitis roughly affects 10-30% of the global population. Commonly refered to as  »allergies », allergic rhinitis is a rather common debilitating health issue. It manifests with sneezing, mucus discharge, itchiness and eventually nasal congestion. Affected population also often presents with secondary fatigue. Allergies may occur at specific periods of the year or present as a chronic condition, since some allergens are prevalent throughout the year. Such is the case of dust mites or mold for example. Furthermore, the majority of afflicted patients may also react to cold air other irritants. Close to 74 M people suffer from allergic rhinitis in North America alone. (1) (17)

Good news: in McDonald’s et al. (2017) literature review, acupuncture treatment for allergic rhinitis is concluded safe, effective and…cost-effective! This exhaustive review produced an impressive list of pathologies for which acupuncture can no longer be ignored in routine care protocols. (2)

The American Journal of Rhinologic Allergy titled a systematic review that concluded acupuncture is a safe and valid option for the treatment of allergic rhinitis. (3) The Otolaryngologic Head, Neck Surgery also published that acupuncture should be put in front of patients by generalists for populations interested in a non pharmacological approach. (4)

Nasal discharge -rhinorrhea- is a glandular, nervous and vascular response. While vasodilation and excretion of fluids are caused by different inflammation mediators and neuropeptids, nasal congestion is related to the vasoactive intestinal peptid. (5)

I challenged one of my colleagues : Dr. John McDonald, an australian acupuncturist whose research and clinical trials shed some shining light on the immunity of mucosal membranes and how they might be affected by acupuncture. (5) (6) The challenge proposed was to summarize, in a single vulgar sentence, the clinical mechanisms of acupuncture in the treatment of allergic rhinitis. Dr. McDonald having realized a clinical trial (7) putting to the test many theories implicating inflammation in the allergic response, I was rather curious of his answer :

Dr. John McDonald :  »Acupuncture down regulates pro-inflammatory neuropeptids such as substance P., the vasoactive intestinal peptide, and total and specific IgE. Acupuncture also reduces the expression and sensitivity of the TRPV1 receptor, the central receptor in the inflammatory response of the acute allergic reaction. »

OK. Right. Allergic rhinitis is related to inflammation. Acupuncture acts on inflammation. The anti-inflammatory effect of acupuncture might explains it’s effectiveness in such a large array of diverse clinical applications. Where does acupuncture for allergies stand in regards to conventional routine care?

EFFICACY + EFFECTIVENESS OF ACUPUNCTURE FOR ALLERGIES

A 2014 study reports the efficacy of acupuncture is similar to loratadine administration. An advantage of acupuncture resides in its long term efficacy. (8) Similarly, a systematic review out in 2009 concluded to the effectiveness and safety of acupuncture + moxibustion in the treatment of allergic rhinitis, but also added that this non pharmacological approach could have advantages that surpass routine medication. (9)

As stated above, downregulation of the vasoactive intestinal peptide is related to relief of clinical allergic symptoms. Interestingly, electroacupuncture demonstrated a greater downregulation of the vasoactive intestinal peptide than administration of cetirizine, a 2^nd generation antihistamine drug, albeit more active than other drugs in that same class. (10)

Better nasal clearance was also observed on patients treated with acupuncture, comparatively to antihistamines. The positive difference was noted immediately after treatment, and 3 months following the treatment. (11)

A 2007 Cochrane review concluded to a weak level of evidence for the treatment of allergic rhinitis by nasal corticosteroids in children. Topic antihistamines are also used in some measure, replacing oral antihistamines in the first stage of the allergic reaction when the nasal discharge is usually superior to the nasal congestion – (13)

Few comparative studies have put nose to nose acupuncture treatment vs antihistamines administration, but Taw MB’s et al. 2015 review (14) class acupuncture on top in terms of efficacy.

COST-EFFECTIVENESS OF ACUPUNCTURE FOR ALLERGIES

My clinical experience as an acupuncturist allowed me to observe that allergies, even perennial, more often, and sooner than later, get better with acupuncture. I noticed that 2-3 series of treatments are necessary on average to overcome chronic allergies, or at least to control symptoms to the point that antihistamine rescue medications are no longer necessary or much less often used than before. If the cost of antihistamines over the course of a lifetime is compared to the usual cost of 3 series of acupuncture treatments spread over 3 years, a quick calculation makes the point for acupuncture. Choosing acupuncture over antihistamines allows for over 15K CAN$ (11K US$) of total lifetime savings. These results may vary on a case by case basis.

A few publications evaluating the cost-effectiveness of acupuncture in the treatment of allergic rhinitis are cited in McDonald’s et al. 2017 litterature review. Amongst which, Kim’s, 2012, and Taw’s, 2015, both conclude that acupuncture is cost-effective for this indication.

In kids, actual evidence simply does not allow a satisfactory answer as far as cost-effectiveness is concerned in the use of antihistamines with inhalators. In fact, corticosteroid inhalators are sometimes considered superior in comparison to non sedative antihistamines for allergic rhinitis, notably because of their cost. There seems to be fewer clinical advantages of combining non steroid antihistamines such as loratadine to an inhalator such as fluticasone. (12) (13)

SAFETY OF ACUPUNCTURE FOR ALLERGIES

The safety of acupuncture treatments is in general well established when the procedure is administered by a properly trained licenced acupuncturist. How about the specific safety profile of the treatments using acupuncture for allergies ?

McDonald et al., 2016 clinical trial is reassuring for the case of acupuncture. No serious side effect was reported, besides minimal cases of slight bruising (2%), transient pain upon needle insertion (0.6%), pain (0.07%), itching (0.07%), slight swelling (0.07%) and tingling (0.07%).

How does this compare to allergic rhinitis specific pharmacological drugs’ safety profiles?

First of all, in kids, the actual population the most commonly suffering from allergic rhinitis, it is not yet possible to answer the question whether it is sufficiently safe to combine non sedative antihistamines to inhalators frequently prescribed for allergic rhinitis. (13)

Note that possible side effects from corticosteroid nasal inhalators by themselves should not be neglected : local irritation of the mucous membrane, burning, sneezing after administration, nasal discharge, perforation of nasal septum, adrenal suppression and growth retardation in children. (13) Whilst some of these events are downright scary, reminding one of some of cocaine’s side effects, others of the lighter side effects of inhalators ironically mimick an allergic reaction!

2nd generation of antihistamines seem generally better than their 1st generation counterparts, but still can cause somnolence, fatigue, headaches and a dry mouth. (13) Loratadine’s side effects, a widespread 2^nd generation antihistamine, at 10mg./day, still may induce these common side effects: somnolence, fatigue, and headaches. Somnolence is a well known side effect of antihistamines : reduction in vigilance, associated with this class of drugs, is considered problematic.  13 different 2^nd generation antihistamines Rx are known to cause somnolence up to a certain point : out of these, 8 scripts don’t allow driving, 3 of them warn against the dangers of driving, while 2 have not issued a notice related to driving a vehicle under their influence. (15)

If you are still not sure what to think, know this : a meta-analysis suggested in 2015 that nasal corticosteroid inhalators might slow down the growth velocity in children. (16) Slowing down the speed at which a child usually develops certainly does not sound legit when there is no reason to do so.

WHAT ABOUT ALLERGEN IMMUNOTHERAPY?

While different approaches have been used to provide safer allergen immunotherapy, adverse reactions to subcutaneous immunotherapy are common. It should be noted that severe systemic adverse allergic reactions may be induced in certain cases by any and every allergen immunotherapy treatment. (18) (19)

CONCLUSION

It appears clear that acupuncture for allergies , administered by a dutifully trained L.Ac., is superior in 4 instances to pharmacological options when it comes to the treatment of allergic rhinitis : efficacy, effectiveness, cost-effectiveness and safety. So, just like mom said…or was it the government? Say no to drugs

See your nice neighborhood acupuncturist. Bring your kids

COI disclosure

Author, Olivier Roy, is a Licensed Acupuncturist

REFERENCES

1. D. V. Wallace, M. S. Dykewicz, D. I. Bernstein et al., “The diagnosis and management of rhinitis: an updated practice parameter,” Journal of Allergy and Clinical Immunology, vol. 122, no. 2, pp. S1–S84, 2008.
2. The Acupuncture Evidence Project A Comparative Literature Review John McDonald Stephen Janz January 2017 (Revised Edition) Commissioned by Australian Acupuncture and Chinese Medicine Association Ltd
3. Am J Rhinol Allergy. 2015 Jan-Feb;29(1):57-62. doi: 10.2500/ajra.2015.29.4116. Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. Feng S1, Han M, Fan Y, Yang G, Liao Z, Liao W, Li H.
4. Otolaryngol Head Neck Surg. 2015 Feb;152(1 Suppl):S1-43. Doi: 10.1177/0194599814561600. Clinical practice guideline: Allergic rhinitis.Seidman MD1, Gurgel RK2, Lin SY3, Schwartz SR4, Baroody FM5, Bonner JR6, Dawson DE7, Dykewicz MS8, Hackell JM9, Han JK10
5. Review Article The Anti-Inflammatory Effects of Acupuncture and Their Relevance to Allergic Rhinitis: A Narrative Review and Proposed Model John L. McDonald,1 Allan W. Cripps,1 Peter K. Smith,1 Caroline A. Smith,2 Charlie C. Xue,3 and Brenda Golianu4, 2012.
6. Mediators, Receptors, and Signalling Pathways in the Anti-Inflammatory and Antihyperalgesic Effects of Acupuncture John L. McDonald, Allan W. Cripps, and Peter K. Smith School of Medicine, Griffith Health Institute, Griffith Health, Griffith University, Southport, QLD 4211, Australia, 2015
7. Effect of acupuncture on house dust mite specific IgE, substance P, and symptoms in persistent allergic rhinitis, John Leslie McDonald PhD, Peter K. Smith, PhD Caroline A. Smith, PhD Charlie Changli Xue, PhD Brenda Golianu, MD Allan W. Cripps, PhD, the Mucosal Immunology Research Group., 2016
8. Zhongguo Zhen Jiu. 2014 Nov;34(11):1083-6. Efficacy on perennial allergic rhinitis treated with acupuncture at three nasal poins and the acupoints selected by syndrome differentiation.
9. L. Xiao, B. Li, Y. H. Du, J. Xiong, and X. Gao, “Systematic evaluation of the randomized controlled trials about acupuncture and moxibustion treatment of allergic rhinitis,” Zhongguo Zhen Jiu, vol. 29, no. 6, pp. 512–516, 2009
10. Y. M. Li, L. X. Zhuang, X. S. Lai, and G. H. Jiang, “Effects of electroacupuncture on plasma vasoactive intestinal peptide and substance P in perennial allergic rhinitis patients,” Zhen Ci Yan Jiu, vol. 32, no. 2, pp. 136–138, 2007.
11. P. Chari, S. Biwas, S. B. S. Mann, S. Sehgal, and Y. N. Mehra, “Acupuncture therapy in allergic rhinitis,” American Journal of Acupuncture, vol. 16, no. 2, pp. 143–147, 1988.
12. Curr Allergy Asthma Rep. 2002 May;2(3):223-30. The cost of treating allergic rhinitis.
13. Antihistamines used in addition to topical nasal steroids for intermittent and persistent allergic rhinitis in children, Cochrane Database of Systematic Reviews, July 2010
14. Acupuncture and allergic rhinitis Malcolm B. Tawa , William D. Reddyb , Folashade S. Omolec , and Michael D. Seidman,Curr Opin Otolaryngol Head Neck Surg. 2015 Jun;23(3):216-20
15. Yakugaku Zasshi. 2017;137(3):315-321. doi: 10.1248/yakushi.16-00237-2. Patients Taking Antihistamines and Their Effects on Driving. Kizu J1.
16. Int Forum Allergy Rhinol. 2015 Feb;5(2):95-103. doi: 10.1002/alr.21430. Epub 2014 Nov 3. Topical intranasal corticosteroids and growth velocity in children: a meta-analysis.Mener DJ1, Shargorodsky J, Varadhan R, Lin SY.
17. Fondation canadienne d’allergie, d’asthme et d’immunologie
18. Laryngoscope. 2014, Mar; 124(3):616-27. doi : 10.1002/lary.24295. Epub 2013 Aug 5. Effectiveness of subcatenous immunotherapy for allergic rhinoconjunctivitis and asthma : a systematic review. Erekosima N, Suarez-Cuervo, Ramanathan M, Kim JM, Chelladurai Y, Segal JB, Lin SY.
19. Allergen immunotherapy in allergic rhinitis: current use and future trends. Klime L, Pfaar O, Bousquet J, Senti G, Kundig T. Laryngoscope.2014 Mar;124(3):616-27. doi: 10.1002/lary.24295. Epub 2013 Aug 5.