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)
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?
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 2nd 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 Cochrane review (Al Sayyad, 2007) concluded to a weak level of evidence for the treatment of allergic rhinitis in children by nasal corticosteroids. 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)
A few comparative studies put nose to nose acupuncture treatment and antihistamines administration : altough some methodological questions have been raised, like is often the case in studies quantifying interventions in opposition to those related to drug testing, the ones retained here (14) all class acupuncture on top in terms of efficacy.
My clinical experience 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 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, choosing acupuncture allows for over 15K CAN$ (11K US$) of total lifetime savings.
A few publications evaluating the cost-effectiveness of acupuncture in the treatment of allergic rhinitis are cited in the litterature review mentionned previously. (McDonald et al., 2017) Amongst which, Kim, 2012, andTaw, 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)
The safety of acupuncture treatments is in general well established when the procedure is administered by a properly trained licenced acupuncturist. How about the safety profile of specific 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 some of cocaine’s side effects, others of the lighter side effects 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 2nd 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 2nd generation antihistamines cause somnolence up to a certain point : 8 of these medications don’t allow driving, 3 of them warn against the dangers of driving, and only 2 haven’t 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.
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 by any and every allergen immunotherapy treatment. (18) (19)
It appears clear that acupuncture for allergies , administered by a duly trained L.Ac., is superior to pharmacological options in 4 ways 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 instead and bring your snotty monsters:):)
Author, Olivier Roy, is a Licensed Acupuncturist