Rhinitis, commonly called runny nose, a group of symptoms associated with inflammation of the mucous membrane inside the nose, also sometimes with the sinus paranasales. These symptoms include sneezing, sometimes coughing, scratching sensation in the nose and throat, runny liquid secretions from the nose, the feeling of blockage of the nasal passages, sometimes headache, itchy eyes, increased body temperature.Rhinitis can have an allergic or other basis, for example, viral infections. It is estimated that allergic rhinitis refers to approximately 18% of the population aged 15-34 and 10% of those aged 35-54.Chemical drugs which are commonly used to treat runny nose mostly have symptomatic effect and are not devoid of side effects, many patients would therefore turn toward treatments other than those offered by mainstream medicine.

Since acupuncture is widely used in treatment of allergic diseases, including bronchial asthma or allergic rhinitis, relatively early its efficacy was investigated by the treatment of allergic rhinitisdisorders.

Inspection of these studies until 2004 didn’t provide a clear answeron the effectiveness of acupuncture (source) 1. With the development of research on acupuncture, the evidences of its effectiveness were rising. The analysis of Chinese researchers, which was published in 2009, already included 1076 patients (source) 2. In the conclusions the authors make a statement that acupuncture and moxibustion are both effective and safe treatments for rhinitis and may be better than the drugs routinely used.

The results of research conducted recently, after the release of the above-discussed surveys, indicate the effectiveness of acupuncture.In 2012, in  prestigious magazine “Allergy” an articlewas published, which summarized a multi-center, randomized clinical trial conducted in Korea and China, which involved 238 patients (source) 3. Acupuncture reduced the symptoms of hay fever measured with TNSS scale (Total Nasal Symptom Score) significantly better than the so-called fake acupuncture.In case of symptoms which were not related to the nose, measured with TNNSS scale (Total Non Nasal Symptoms Score), both acupuncture and so-called false acupuncture resulted in a significant reduction of those symptoms, compared to patients who did not receive the acupuncture treatment. This study once again showed that acupuncture is safe and effective therapy.Another study was conducted by Brinkhous team and covered 5237 patients (source) 4. It has shown that acupuncture in addition to the routine treatment of patients, also brings both statistically and clinically significant benefits. The results of this team’s latest experiment were published in 2013 in the “Annals of Internal Medicine” (source) 5. The study involved 46 specialized doctors from 38 centers and 422 patients were recruited. Acupuncture resulted in a statistically significant improvement in patients measured with RQLQ scale(Rhinitis Quality of Life Questionnaire).

In parallel to the clinical trials demonstrating the efficacy of acupuncture in the treatment of hay fever, brave scientists try to explain the mechanisms of action of this unique method. In 2008 a pioneering work on the effects of acupuncture on the expression of specific genes in patients with allergic rhinitis was published (source) 6. The therapeutic effect was measured by using the RQLQ scale(Rhinitis Quality of Life Questionnaire), but further analysis of gene expression was performed using the cDNA microarrays. Acupuncture has proven to be effective in reducing symptoms. This effect was confirmed by significant reduction in receptor of Interleukin-1 alpha gene expression(IL1R1), which affects the balance between pro-inflammatory and anti-inflammatory cytokines derived from T-helper 1 and T-helper-2 cells.

The same team has confirmed the changes described above in the next experiment (source) 7, this time they examined the differences between the effectiveness of acupuncture and gene expression, depending on the initial level of IgE. Since both the effectiveness and the changes in expression of genes encoding pro-and anti-inflammatory substances differ among the groups according to their initial characteristics, the authors in their conclusions encourage to personify the diagnosis and treatment.

In 2013 a very interesting piece of work was published, which in an accessible way summarizes the molecular mechanisms of inflammation in the nose and the effect of acupuncture at different stages of the process (source) 8. The authors, basing on the literature, covered nearly one hundred scientific articles, offering a coherent description of acupuncture for allergic rhinitis.

From the experiments on the animal models, it is known that the acupuncture has an impact on the hormonal activity of the hypothalamic-pituitary-adrenal axis, increasing the secretion of ACTH and corticosteroids, which may lead to reduce swelling of the nasal mucosa in the course of a cold.

Acupuncture has an impact on releasing the norepinephrine by the sympathetic nervous system, which by connecting to the β-2 receptors on the leukocyte level, affects the migration leading to reduce swelling.

Another impact of acupuncture on allergic reaction is an antihistamine effect, probably achieved by reducing the signaling of TRPV1 receptor which leads to a proven in the studyreduction of pruritus.

As described above, acupuncture also has a significant effect in reducing the levels of pro-inflammatory cytokines and increase the anti-inflammatory cytokines, influencing the Th1/Th2 balance.

Proven in numerous studiesthe effect of acupuncture on the release of endogenous opioids, in particular the enkephalins, is associated with the inhibition of the release of P substance from the peripheral nerve endings. What is more, the opioid receptors have been identified in many cells of the immune system, although their role in anti-inflammatory effect of acupuncture requires further study.

Acupuncture, significantly better than drugs, reduces the release of vasoactive intestinal peptide (VIP), and like drugs, reduces the release of P substance, which also explains, at least in it’s parts of its anti-inflammatory effect of causing inhibition of mast-cells degranulation, preventing excessive vasodilatation and extravasation of the plasma.

Additionally, acupuncture inhibits the signaling using TRPV1 receptor, in currently unknown mechanism. This receptor plays an important role, especially in the early allergic response, and is responsible for nasal itching and sneezing, and the production of CGRP and P substance.

The above-mentioned operation once again proves that acupuncture has certain therapeutic effects through complex interactions involving different molecular mechanisms at the same time on different stages of given process.

Similarly presented in the case with the anti-inflammatory action of acupuncture in the treatment of asthma and COPD, positive clinical results are also confirmed by allergic rhinitis and are explained by studies on animal models.Korean scientists are the authors of the article printed in 2012 in “Otolaryngology – Head and Neck Surgery” (source) 9. In the experiment which was designed and conducted by them, the acupuncture resulted in a significant reduction in allergic reaction in the nose by reducing the expression of P substance , STAT6, NF-kappaB and iNOS.

In addition, the German ACUSAR research shows that acupuncture is an effective method of improving the quality of life of patients suffering from allergic rhinitis (source) 10. The authors conclude that the assessment of cost-effectiveness must be adapted to the current state of the health care system and in time of it’s crisis, the acupuncture can not be economically justified.

Acupressure is derived from acupuncture and consists in pressing certain points of the body. In 2010 a review of researches on the effectiveness of ear acupressure in relieving symptoms of hay fever was published (source) 11. Although the authors emphasize the poor quality of the quoted studies, however they indicate that taking into account the short-term effects of ear acupressure was more effective than the use of herbs and just as effective as corporal acupuncture or antihistamines. Moreover, it was more effective than the last one in terms of long-term effect.

STRENGTH OF EVIDENCE
Power of arguments
BIBLIOGRAPHY

1 Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R, Price D, Bousquet J. “ARIA update: I–Systematic review of complementary and alternative medicine for rhinitis and asthma.” J Allergy Clin Immunol. 2006 May;117(5):1054-62.

2 Xiao L, Li B, Du YH, Xiong J, Gao X “Systematic evaluation of the randomized controlled trials about acupuncture and moxibustion treatment of allergic rhinitis”. Zhongguo Zhen Jiu. 2009 Jun;29(6):512-6. – artykuł w języku chińskim

3 Choi S-M, Park J-E, Li S-S, Jung H, Zi M, Kim T-H, Jung S, Kim A, Shin M, Sul J-U, Hong Z, Jiping Z, Lee S, Liyun H, Kang K, Baoyan L. “A multicenter, randomized, controlled trial testing the effects of acupuncture on allergic rhinitis.” Allergy 2013; 68: 365–374.

4 B. Brinkhaus, C. M. Witt, S. Jena, B. Liecker, K. Wegscheider, and S.N.Willich, “Acupuncture in patients with allergic rhinitis: a pragmatic randomized trial,” Annals of Allergy, Asthma and Immunology, vol. 101, no. 5, pp. 535–543, 2008.

5 Brinkhaus B, Ortiz M, Witt CM, Roll S, Linde K, Pfab F, Niggemann B, Hummelsberger J, Treszl A, Ring J, Zuberbier T, Wegscheider K, Willich SN. “Acupuncture in patients with seasonal allergic rhinitis: a randomized trial.” Ann Intern Med. 2013 Feb 19;158(4):225-34.

6 Shiue HS, Lee YS, Tsai CN, Hsueh YM, Sheu JR, Chang HH “DNA microarray analysis of the effect on inflammation in patients treated with acupuncture for allergic rhinitis.” J Altern Complement Med. 2008 Jul;14(6):689-98.

7 Shiue HS, Lee YS, Tsai CN, Hsueh YM, Sheu JR, Chang HH. “Gene expression profile of patients with phadiatop-positive and -negative allergic rhinitis treated with acupuncture” J Altern Complement Med. 2010 Jan;16(1):59-68

8 John L. McDonald, Allan W. Cripps, Peter K. Smith, Caroline A. Smith, Charlie C. Xue, and Brenda Golianu, “The Anti-Inflammatory Effects of Acupuncture and Their Relevance to Allergic Rhinitis: A Narrative Review and Proposed Model,” Evidence-Based Complementary and Alternative Medicine, vol. 2013, Article ID 591796, 12 pages, 2013. doi:10.1155/2013/591796

9 Jung D, Lee S, Hong S. “Effects of acupuncture and moxibustion in a mouse model of allergic rhinitis.” Otolaryngol Head Neck Surg. 2012 Jan;146(1):19-25

10 Reinhold T, Roll S, Willich SN, Ortiz M, Witt CM, Brinkhaus B. “Cost-effectiveness for acupuncture in seasonal allergic rhinitis: economic results of the ACUSAR trial.” Ann Allergy Asthma Immunol. 2013 Jul;111(1):56-63

11 Zhang CS, Yang AW, Zhang AL, Fu WB, Thien FU, Lewith G, Xue CC. “Ear-acupressure for allergic rhinitis: a systematic review” Clin Otolaryngol. 2010 Feb;35(1):6-12

THE AUTHOR