Jamie Gisby

Allergic Rhinitis

Acupuncture for Allergic Rhinitis?

Allergic Rhinitis – What is it?

According to NHS Choices:

Allergic rhinitis is inflammation of the inside of the nose caused by an allergen, such as pollen, dust, mould or flakes of skin from certain animals.

It’s a very common condition, estimated to affect around one in every five people in the UK.

Allergic rhinitis typically causes cold-like symptoms, such as sneezing, itchiness and a blocked or runny nose. These symptoms usually start soon after being exposed to an allergen.

Some people only get allergic rhinitis for a few months at a time because they are sensitive to seasonal allergens, such as tree or grass pollen. Other people get allergic rhinitis all year round.

Most people with allergic rhinitis have mild symptoms that can be easily and effectively treated. However, for some, symptoms can be severe and persistent, causing sleep problems and interfering with everyday life.

The symptoms of allergic rhinitis do occasionally improve with time, but this can take many years and it is unlikely that the condition will ever disappear completely.

Can Acupuncture Help Allergic Rhinitis?

There have been at least 5 randomised trials which have found acupuncture to be effective as a treatment for allergic rhinitis.  For example:

A randomised controlled trial that assessed the effectiveness of acupuncture in addition to routine care in patients with allergic rhinitis compared with treatment with routine care alone. Patients were allocated to receive up to 15 acupuncture sessions during a period of 3 months or to a control group receiving no acupuncture. All were allowed to usual medical care. The Rhinitis Quality of Life Questionnaire (RQLQ) and general health-related quality of life (36-Item Short-Form Health Survey) were evaluated at baseline and after 3 and 6 months. Of 5,237 patients, 487 were randomly assigned to acupuncture and 494 to control, and 4,256 were included in the nonrandomized acupuncture group. At 3 months, the RQLQ improved by a mean) of 1.48 in the acupuncture group and by 0.50 in the control group (p<0.001). Similarly, quality-of-life improvements were more pronounced in the acupuncture verses the control group (p<0.001). The researchers concluded that results suggest that treating patients with allergic rhinitis in routine care with additional acupuncture leads to clinically relevant and persistent benefits.

Brinkhaus B et al. Acupuncture in patients with allergic rhinitis: A pragmatic randomized trial. Annals of Allergy, Asthma and Immunology 2008; 101: 535-43.

Another randomised trial found that acupuncture was ‘cost effective’:

Overall costs (direct and indirect) in the acupuncture group were significantly higher than those in the control group (Euro 763 vs. Euro 332) but this was more than balanced by the improvement in quality of life. The incremental cost-effectiveness ratio was 17,377 per quality-adjusted life year. The researchers concluded that acupuncture, supplementary to routine care, was cost-effective according to international benchmarks,. However, because of the study design, it remains unclear whether the effects are acupuncture specific.

Witt CM et al. Cost-effectiveness of acupuncture in women and men with allergic rhinitis: A randomized controlled study in usual care. American Journal of Epidemiology 2009; 169: 562-71.

The American Academy of Otolaryngology’s new Clinical Practice Guideline recommends acupuncture for patients with allergic rhinitis  (AR) who are interested in non-pharmacological therapy (treatment without drugs).

More research can be seen in the British Acupuncture Council’s fact sheet on allergic rhinitis.

A recent review has yielded a positive perspective:

Purpose of review: Allergic rhinitis has a high prevalence and negatively impacts quality of life. Patients commonly use complementary and integrative modalities to help alleviate their symptoms of allergic rhinitis, with approximately one in five receiving acupuncture. This article reviews the evidence base on the efficacy/effectiveness, safety and cost-effectiveness of acupuncture for allergic rhinitis.

Recent findings: Our review of the medical literature from January 2013 through December 2014 revealed that there is research demonstrating efficacy and effectiveness for acupuncture in the treatment of allergic rhinitis, as well as improvement of quality of life and quality-adjusted life-years.

Summary: There are high-quality randomized controlled trials that demonstrate efficacy and effectiveness for acupuncture in the treatment of both seasonal and perennial allergic rhinitis. Smaller head-to-head studies also show some preliminary benefit of acupuncture when compared with antihistamines, but these had a variety of methodological limitations. Further studies of higher quality are needed, particularly with a focus on comparative effectiveness research.

Current Opinion in Otolaryngology & Head & Neck Surgery:
June 2015 – Volume 23 – Issue 3 – p 216–220
doi: 10.1097/MOO.0000000000000161
ALLERGY: Edited by Sandra Y. LinCould your rhinitis relate to allergies?

Allergies and food sensitivities can be part of the cause of rhinitis and I will often explore this possibility with patients.

Could your rhinitis be a migraine?

Leading American neurologist David Buchholz of John Hopkins university has a novel theory that persistent rhinitis could actually be caused by migraines.  This makes sense when you realize that the nose and sinuses are innervated by the facial nerve which is a cranial nerve.  If a migraine is in a certain part of the brain it can irritate the facial nerve causing all the symptoms of allergic rhinitis.  This certainly explains why so often conventional treatment for rhinitis is ineffective.  In his book he outlines a 3 step program for resolving headaches, migraines and a whole host of ‘head’ related symptoms: Heal Your Headache.