Acupuncture in addition to budesonide does not further improve RQLQ apart from the sleep domain

S-Z Wang,Q Xie,S Chen,Y Zhang,J-P/ Zhao,W-M Zeng,S-N Guo,S-H Qu

doi:10.4193/rhinol/20.053

Abstract

BACKGROUND: Acupuncture can effectively alleviate the nasal symptoms of allergic rhinitis (AR); however, the mechanism is unclear. Previous studies suggested it may be related to improve hypothalamus-pituitary-adrenal (HPA) axis dysfunction. MATERIALS and METHODS: The study was a randomised controlled trial including ninety patients with moderate to severe persis- tent AR. Subjects were randomised 1:1:1 to the 8-weeks treatment with mind-regulating acupuncture combined with intranasal glucocorticosteroids (INGC), conventional acupuncture combined with INGC and INGC alone (MA, CA, GC respectively). The primary outcome was the change from baseline in the Visual Analogue Scale (VAS) score of nasal symptoms. Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) score was a key secondary outcome. The levels of corticotrophin releasing hormone (CRH), cortisol (COR) and adrenocorticotropic hormone (ACTH) were also analysed. RESULTS: MA, CA and GC reduced VAS score and total RQLQ by a similar degree, but the sleep domain of RQLQ significantly impro- ved in MA and CA compared to GC. Meanwhile, the COR and ACTH level increased, and CRH level decreased after treatment in MA and CA, but the changes showed no difference among the three groups after Bonferroni correction. CONCLUSIONS: Although acupuncture combined with INGC may have potential effect on sleep quality, the combination therapy cannot further improve nasal symptoms or RQLQ compared to INGC alone in AR patients. The influence of acupuncture on HPA axis needs to be further explored.

Highlights

Acupuncture has been used to treat allergic rhinitis (AR) in China for a long time and promoted worldwide [1]
MA, CA and GC reduced Visual Analogue Scale (VAS) score and total Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) by a similar degree, but the sleep domain of RQLQ significantly improved in MA and CA compared to GC
Conclusions: acupuncture combined with intranasal glucocorticosteroids (INGC) may have potential effect on sleep quality, the combination therapy cannot further improve nasal symptoms or RQLQ compared to INGC alone in AR patients

Summary

Introduction

Acupuncture has been used to treat allergic rhinitis (AR) in China for a long time and promoted worldwide [1]. The clinical evidence of the acupuncture’s value in the treatment of AR was controversial. [11] The protocol of acupuncture treatment in China varies in the selection of acupoints and the operation [7]. Since most AR patients have negative emotional states and sleep disturbances [8], conventional acupoints may not satisfy the clinical needs. In traditional Chinese medicine (TCM) theory, mood disorders and sleep disturbance belong to the "mind disease" interacting with the primary disease which is similar to the concept “Psychosomatic disorder in western medicine”. Acupuncture doctors usually choose the mind-regulated acupoints in addition to conventional acupoints for AR patients to improve the overall. Acupuncture can effectively alleviate the nasal symptoms of allergic rhinitis (AR); the mechanism is unclear. Previous studies suggested it may be related to improve hypothalamus-pituitary-adrenal (HPA) axis dysfunction

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