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Is acupuncture effective for allergies?

(Image by Sergio Huainigg from Pixabay)

The third week in April is #allergyawarenessweek so I thought I'd discuss whether acupuncture is effective for allergies in this month's blog. An allergy is defined by the British Society for Immunology as a 'harmful, misguided and over-zealous immune response to antigens that causes tissue damage and disease'.

Allergic rhinitis (which is the medical term which describes the symptoms we typically think of as hayfever - streaming eyes, runny nose, blocked nose/sinus passages and excessive sneezing) is widespread with 20-30% of the population effected - that's pretty much one person in every family! However despite the name 'hayfever' although grass and tree pollens are common triggers they are by no means the only ones - many people with these sensitivities are battling several triggers at once and it can severely affect their quality of life (1).

With such large numbers at play it is no surprise that treating allergies is big business -

about 1.0–1.5 billion Euros in direct costs and at least one billion Euros in additional indirect costs such as time off work, poor productivity etc. (2) However it could be true that a large part of this scenario is self-inflicted, with the study (1) suggesting that increased prevalence and severity of allergic disease could be "a consequence of a westernized lifestyle, which, by virtue of increases in air pollution, the time spent indoors/lifestyle changes, exposure to both traditional and a variety of novel allergens and psychological stress associated with the lifestyle changes...increases the risk of sensitisation". Sadly the paper concluded that more early pharmacological interventions were the answer rather than mitigating these wider issues which are making our societies sicker and more medication-dependant than ever :(

What about our pets?

Well sadly our pets are subject to most of the vices of our western lifestyles too, although the most common syndrome we see as vets is atopic dermatitis (AD) which is akin to human eczema and produces symptoms such as licking, scratching and chewing of feet, belly, and groin and recurrent ear infections. As a vet in general practice I see such cases on a daily basis and as a recent review puts it: "The chronic and often severe nature of the disease, the costly diagnostic workup, frequent clinical flares and lifelong treatment are challenging for owners, pets and veterinarians". (3)

It can take many tests to get to the bottom of what is causing the disease (if indeed there is a single 'cause'), treatments such as ongoing corticosteroids or immune modifying drugs can be expensive with unpleasant side effects and so there is a definite need for other approaches.

The problem with evidence

So what evidence do we have about the effectiveness of acupuncture? Well as in other areas, many scientists with a Western medical background will dismiss the many studies that have been published as they do not adhere to the standard of a randomised placebo-controlled double-blinded trial. Such studies are considered the highest standard of proof of efficacy of a treatment intervention such as a new drug because they are a) 'randomised' so the subjects receiving the treatment are randomly picked from the pool of all available patients - so as long as your pool is large enough there should be a range of backgrounds, gender, disease severity and so on; b) placebo-controlled so that a proportion of the study pool receive a 'sham' treatment to rule out the 'placebo effect' i.e. just having 'a treatment' makes both patient and doctor unconsciously tend towards seeing an improvement and c) double-blinded so both patients and doctors are unaware who is receiving the sham vs. genuine treatment.

Acupuncture, like any other manual or physical intervention such as massage therapy, exercise programmes or heat/cold therapy are difficult to provide in a 'sham' form - I think I'd know if I was told I was having a massage treatment whether it was really happening or not....

Some studies try to get around this by using a 'sham acupuncture' treatment group, where the needles are inserted at points other than recognised acupuncture points or very superficially. My concern with this, is that (if you have heard my acupuncture talk!) many of the beneficial effects of needling occur in direct local response to the tissue to the point of the needle - so these do not depend on location! I'm not sure therefore, whether there can be a true 'sham' acupuncture treatment at least in humans. But just like massage therapy, that does not mean it is ineffective.

The beautiful images of connective tissue 'winding' around the point of an acupuncture needle produced by Langevin and colleagues - this can occur wherever you put the needle! (4)

So, if we can't rely on some nice RCTs what evidence do we have?

Well there are molecular studies looking at the levels of chemical signalling molecules, immune cells and other markers in the blood of acupuncture treated patients alongside non-treated patients. For example it has been pretty well proven that a major mechansim in the development of an allergic disease in humans is the alteration of the ratio of Th1/Th2 cells (1) and this same mechanism is seen in canine AD (5). Similarly production of chemical signallers interleukin (IL)4 and 13 are involved in the itch and inflammation seen in both dogs and humans. There are studies showing that acupuncture can directly reduce levels of interleukins in the blood of patients with allergic rhinitis e.g. (6) and broader studies such as (7) which indicate electracupuncture effects on several aspects of immune function.

Other studies such as (8) review symptoms and medication use in treated and non-treated (human) patients and have shown a 'statistically significant' effect but concluded this may not be clinically significant - in other words not as pronounced as they would like to recommend it as a valid treatment option in preference to other established treatments.

So what is the conclusion?

My own personal stance is that we know that acupuncture responses can vary widely from one individual to the other, with some people such as myself responding very well, and others seeing little or no benefit (up to 20%). So in a large population study to see a 'statistically signficant' effect is not to be sniffed at. Any drug with a 20% non-response rate would still be considered a valid option if the condition it was treating had a severe effect on quality of life. We also know that in allergy treatment there is a rarely a single 'silver bullet' option, with a multimodal approach (e.g. allergen avoidance, symptom relieving medications, immune modulating therapies) used in conventional medical cases.

So why not see acupuncture as an extra tool to add to the toolbox? Extremely safe, side-effect free and it may just make the difference to your pet's quality of life!

  1. Mösges, R. and Klimek, L., 2007. Today’s allergic rhinitis patients are different: new factors that may play a role. Allergy, 62(9), pp.969-975.

  2. 2. Hauswald B, Yarin YM. Acupuncture in allergic rhinitis: A Mini-Review. Allergo J Int. 2014;23(4):115-119. doi: 10.1007/s40629-014-0015-3. Epub 2014 Jun 21. PMID: 26120523; PMCID: PMC4479426.

  3. Gedon NKY, Mueller RS. Atopic dermatitis in cats and dogs: a difficult disease for animals and owners. Clin Transl Allergy. 2018 Oct 5;8:41. doi: 10.1186/s13601-018-0228-5. PMID: 30323921; PMCID: PMC6172809.

  4. Langevin et al 2002 FASEB J. Jun;16(8):872-4.

  5. Simon P. Früh et al 2020 Vet Immunology and Immunopathology 221:110015, ISSN 0165-2427,

  6. Petti FB1, Liguori A, Ippoliti F., 2002. J Traditional Chinese Medicine 22(2):104-111

  7. Kim, S.K. and Bae, H., 2010. Autonomic Neuroscience, 157(1-2), pp.38-41.

  8. Brinkhaus, B., Ortiz, M., Witt, C.M., Roll, S., Linde, K., Pfab, F., Niggemann, B., Hummelsberger, J., Treszl, A., Ring, J. and Zuberbier, T., 2013. Annals of internal medicine, 158(4), pp.225-234.

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