알레르기 비염에 침 치료가 도움이 될까? 항히스타민제와 비교한 임상시험 30편 분석

Background In this study, we attempted to assess the efficacy and safety of acupuncture for allergic rhinitis (AR), and to test the robustness of the estimated effects. Methods The Cochrane methodology standard was followed to conduct this systematic review. Randomized controlled trials (RCTs) comparing acupuncture with other therapies for AR were included. Furthermore, trial sequential analysis was conducted to test the robustness of pooled results. Thirty trials with 4413 participants were included. Results Acupuncture improved the nasal symptoms on Total Nasal Symptom Score (TNSS) and quality of life measured by Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) in adults with AR, compared to acupuncture with no intervention. Acupuncture was also shown to be more effective than sham acupuncture for nasal symptom (RQLQ subscale, n = 489, MD − 0.60, 95% CI − 1.16 to − 0.04) and quality of life (RQLQ, n = 248, − 8.47 95% CI − 14.91, − 2.03). No clear difference was observed between acupuncture and cetirizine or loratadine. Interestingly, trial sequential analysis (TSA) failed to confirm the aforementioned results. The effect of acupuncture for children/adolescents with AR remains unclear due to insufficient data. The performance bias and attrition bias are serious in most studies that were included. Selection bias may also have affected the quality of the evidence. Conclusion Acupuncture may have an advantage over no intervention and sham acupuncture in improving nasal symptoms and quality of life for adults with AR. The effect of acupuncture and cetirizine or loratadine for AR may be similar. Additional trials are necessary to confirm these results. Supplementary Information The online version contains supplementary material available at 10.1186/s40001-022-00682-3.

Conclusion For adults with AR, acupuncture is superior to no intervention and sham acupuncture in lowering the severity of nasal symptoms and improving the life quality of patients. The effect of acupuncture and cetirizine/loratadine may be similar. Whether acupuncture can decrease the serum level of immune response molecules is still uncertain. The effect of acupuncture on children with AR remains unclear. Future trials with well-randomized assignments are required. More trials are indeed required to evaluate the effect of acupuncture on children with AR. Further trials are also needed to evaluate the difference between real acupuncture and sham acupuncture for AR, as the data are insufficient at present. When measuring the clinical response, investigators of future trials should utilize objective definitions with a unified minimal clinical importance threshold value. Future studies should aim to explore whether different treatment durations of acupuncture influence the treatment effect and whether the effect of acupuncture varies in patients from different countries.