A B S T R A C T
Background: Clinical evidence suggests that acupuncture improves symptoms in persistent allergic rhinitis,
but the physiologic basis of these improvements is not well understood.
Objective: A randomized, sham-controlled trial of acupuncture for persistent allergic rhinitis in adults
investigated possible modulation of mucosal immune responses.
Methods: A total of 151 individuals were randomized into real and sham acupuncture groups (who received
twice-weekly treatments for 8 weeks) and a no acupuncture group. Various cytokines, neurotrophins,
proinflammatory neuropeptides, and immunoglobulins were measured in saliva or plasma from baseline to
4-week follow-up.
Results: Statistically significant reduction in allergen specific IgE for house dust mite was seen only in the
real acupuncture group, from 18.87 kU/L (95% CI, 10.16e27.58 kU/L) to 17.82 kU/L (95% CI, 9.81e25.83 kU/L)
(P ¼ .04). A mean (SE) statistically significant down-regulation was also seen in proinflammatory neuropeptide
substance P (SP) 18 to 24 hours after the first treatment from 408.74 (299.12) pg/mL to 90.77 (22.54)
pg/mL (P ¼ .04). No significant changes were seen in the other neuropeptides, neurotrophins, or cytokines
tested. Nasal obstruction, nasal itch, sneezing, runny nose, eye itch, and unrefreshed sleep improved
significantly in the real acupuncture group (postnasal drip and sinus pain did not) and continued to improve
up to 4-week follow-up.
Conclusion: Acupuncture modulated mucosal immune response in the upper airway in adults with
persistent allergic rhinitis. This modulation appears to be associated with down-regulation of allergen
specific IgE for house dust mite, which this study is the first to report. Improvements in nasal itch, eye
itch, and sneezing after acupuncture are suggestive of down-regulation of transient receptor potential
vanilloid 1.
Trial Registratio
Real Acupuncture Treatment
Acupuncture point selection
The rationale for acupuncture point selection in this study was based on 3 sources of data: points frequently used in research studies, points frequently recommended in modern acupuncture textbooks in the clinical sections, and finally points for which indications relevant to allergic rhinitis frequently appear in the point indications sections of modern texts.8e23 The following points were chosen for this study: Yintang, LI 20, LI 4, ST 36, and GV 23. All
points were located according to the World Health Organization International Standard Acupuncture Point Locations in theWestern Pacific Region.24
Duration and Frequency of Acupuncture Treatment
A review of previous studies on acupuncture for allergic rhinitis indicated that a treatment regimen of twice-weekly treatments for 6 to 8 weeks produced significantly superior clinical outcomeswhen compared with studies that used shorter or less frequent treatments.8e14,25e27 Therefore, treatments were given twice weekly for 8 weeks, with a 2- to 4-day break between treatments.
Needle Technique
Traditional Chinese-style single-use disposable stainless steel needles (0.25 _ 40 mm) (C and G acupuncture needles; Helio Supply Co Pty Ltd, Sydney, Australia) were used. The needles were
inserted at the indicated points but not manipulated. Yintang, LI 20, and GV 23 were needled obliquely to a depth of 3 to 5 mm, whereas LI 4 and ST 36 were needled perpendicularly to a depth of 10 to 15
mm. Needles were retained for 20 minutes (without manipulation) and then removed.
Time of Treatment
To reduce the influence of circadian variations, all acupuncture
treatments were performed between 6 AM and midday, twice
weekly.
Sham Acupuncture Treatment
Nonechannel points used in sham acupuncture protocols have been shown not to be inert28,29; however, because there is no sham acupuncture protocol that has been validated as inert,30,31 needling nonechannel points was the most appropriate invasive sham protocol available.
Acupuncture point selection
For the sham acupuncture group, 4 sites (needled bilaterally)
were selected, which did not correspond to the locations of known
acupuncture points and did not lie on identified acupuncture
channels (meridians). Midline points on the head were avoided
because this would lie on an identified acupuncture channel, the
governor vessel (Dumai). The acupuncture points were as follows:
forehead sham point: 1 cun lateral to GB 14 (Yangbai); cheek sham
point: the midpoint of the line between LI 20 and SI 19 (Tinggong);
hand sham point: on the dorsum of the hand, at the midpoint of the
second metacarpal bone on the ulnar side of the bone; and leg
sham point: on the lateral aspect of the lower leg, 1 cun below the
point Linghou (M-LE-24). The forehead sham point was needled
obliquely, whereas the cheek sham was needled perpendicularly,
both to a depth of 2 to 3 mm. Hand and leg sham points were
needled perpendicularly to a depth of 5 to 10 mmand 10 to 15 mm,
respectively.
Studienautoren: John Leslie McDonald, PhD *; Peter K. Smith, PhD *; Caroline A. Smith, PhD y; Charlie Changli Xue, PhD z;
Brenda Golianu, MDx; Allan W. Cripps, PhD *; the Mucosal Immunology Research Group
Quelle: scienceDirect