Warm Needling

Min He et al. (2022) · European journal of medical research

This systematic review and meta-analysis combined 30 randomised controlled trials with 4,413 participants to test whether acupuncture helps allergic rhinitis — the sneezing, congestion and runny nose caused by an allergic reaction in the lining of the nose. What sets it apart is that the authors then stress-tested their own findings using trial sequential analysis, a method that asks whether enough participants have been studied for a pooled result to be trusted rather than treated as a chance finding. Trials came mostly from China (22 of 30), with others from Germany, Australia, South Korea and Sweden, ranging from 24 to 981 participants and lasting between two and twelve weeks. Three needling approaches were used: standard needle acupuncture, electroacupuncture, and warm needling, in which mugwort is burned on the needle to heat it. Acupuncture was compared against no treatment, against sham needling at non-acupuncture points, and against antihistamines including cetirizine and loratadine. Symptoms were scored with the Total Nasal Symptom Score and quality of life with the Rhinoconjunctivitis Quality of Life Questionnaire. Against no treatment, acupuncture improved both nasal symptoms and quality of life in adults. Against sham needling it also came out ahead, improving nasal symptoms (mean difference -0.60, 95% CI -1.16 to -0.04, from 489 participants) and quality of life (mean difference -8.47, 95% CI -14.91 to -2.03, from 248 participants) — both statistically significant, since neither confidence interval crosses zero. Against cetirizine or loratadine no clear difference appeared, suggesting acupuncture performs about as well as standard antihistamines. But the trial sequential analysis failed to confirm any of these results, meaning the pooled evidence has not yet accumulated enough participants to be considered reliable. Effects in children and adolescents could not be determined at all. The honest summary is a promising signal that has not yet been confirmed. Performance and attrition bias were serious in most of the included trials, and the authors' own robustness check contradicted their own positive findings. For an adult who would rather not take daily antihistamines, acupuncture is a defensible option on current evidence; it is not yet a demonstrated one. Larger and better-conducted trials, especially in children, are what would settle the question.