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Chapter 13B
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Role of Acupuncture in Allergic Disorders
Parin Niranjan Parmar1,* and Pudupakkam K. Vedanthan
2
Introduction
Acupuncture is one of the most important treatment methods in Traditional Chinese Medicine (TCM)
- a system of healing that was developed in China. Similarly, in some of the Eastern countries, a vast
number of herbs have been used tradtionally for treatment of allergic disorders for centuries. This
chapter aims to discuss the role of acupuncture and herbal medicine in alllergy and various allergic
disorders.
Basics of Acupuncture
Acupuncture plays an important role in healthcare in China Korea, Japan, Taiwan and Hong Kong.
For the purpose of understanding acupuncture, it is important to know that Qi (pronounced as “chi”)
refers to the energy or vital force that keeps a living being alive. Meridians are the channels or
pathways through which Qi flows, and acupuncture points are the points from where it is possible
to influence the flow of Qi as well as the functioning of organs and tissues connected with the
meridians. Until late in the second half of the twentieth century, meridians and acupuncture points
were considered abstract and “non-existent” in the human body but recently several attempts have
been made to identify and define them anatomically and physiologically (Maurer et al. 2019; Li et al.
2012). A recent systematic review has supported the existence of meridians and acupuncture points
based on their electric, thermal, acoustic, optical, magnetic, isotopic and myoelectric characteristics
(Li et al. 2012).
As per TCM, stimulation of acupuncture points can regulate the flow of Qi in the meridians
and therefore it is possible to influence the functioning of internal organs by regulating the flow
of Qi within the meridians connected with the corresponding organs. In addition to acupuncture,
the points can also be stimulated by pressure, heat, cold, laser or other stimuli. Important steps
of an acupuncture treatment are TCM diagnosis (i.e., diagnosis of imbalance within the person’s
body based on TCM principles), selection of acupuncture points based on TCM diagnosis, needling
(insertion of acupuncture needles at the points) (Figure 1) and stimulation of the acupuncture points
(manually or electrically). In a typical acupuncture session, the selected acupuncture points are
1
Pediatric Allergy Consultant and Integrative Medicine Consultant, Rajkot, Gujarat, India.
2
The University of Colorado at Anschutz Campus, Aurora, Colorado. USA.
* Corresponding author: parinmnparmar@gmail.com
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Figure 1. An acupuncture needle.
stimulated for 20 to 30 minutes. The frequency of the sessions usually ranges from once daily
to twice weekly, and the duration of acupuncture treatment can range from a few weeks to a few
months.
Based on various animal and human studies to date, beneficial effects of acupuncture
in allergic disorders occur from a combination of multiple mechanisms such as complex
neuro-endocrine-immunological interactions, anti-inflammatory effects mediated via hypothalamuspituitary-adrenal axis and autonomic nervous system, altered cytokine responses, alterations in local
blood flow, centrally mediated antipruritic effect and reduction in perceived and physiologic stress
(McDonald et al. 2013; Yu et al. 2015).
Acupuncture in Allergic Disorders: Evidence
Allergic Rhinitis
Based on the evidence to date, acupuncture has shown beneficial effects significantly better
in patients with allergic rhinitis as compared to other allergic disorders. Some of the clinical
practice guidelines (Seidman et al. 2015; Cheng et al. 2018) also support the use of acupuncture
as an important non-pharmacological intervention in the treatment of allergic rhinitis. A recent
systematic review (Yin et al. 2020) and meta-analysis included 39 randomized controlled trials with
3,433 participants and showed that acupuncture was superior to sham acupuncture in improving
total nasal symptoms score and quality of life in patients with allergic rhinitis. A recently published
overview of systematic reviews and network meta-analysis (Zhang et al. 2020) compared the
efficacy of different acupuncture therapies alone with that of conventional medicines and showed
that manual acupuncture at the sphenopalatine ganglion point and San-Fu-Tie (a method of the
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herbal application over specific points on specific days during the year as per TCM) were more
effective than conventional medicines for improving allergic rhinitis symptoms at 3, 6 and
12 months follow-up.
In addition to conventional acupuncture based on TCM diagnosis, acupuncture at the
“sphenopalatine ganglion acupuncture point” requires special mention. The point is located between
the zygomatic arch and coronoid of the mandible near the ST7 point and the needle is inserted
through the point to reach the pterygopalatine fossa; both manual acupuncture and electroacupuncture
have been used and both unilateral and bilateral sphenopalatine ganglion acupuncture have shown
effectiveness. Possible mechanisms of this technique include stimulation of sympathetic nerve fibers
in the local region causing vasoconstriction, reduced blood flow to the nasal mucosa and cavernous
body, reduced glandular secretion and increased nasal ventilation (Zhang et al. 2020; Fu et al. 2019).
A systematic review and meta-analysis involving ten studies and 943 participants concluded that
acupuncture at only sphenopalatine ganglion acupuncture point is effective in relieving symptoms
and improving quality of life in patients with allergic rhinitis as compared to acupuncture at other
conventional points, sham acupuncture and Western medicine (Fu et al. 2019). However, the
researchers felt the need for more studies because of the high heterogeneity of the studies included
in the meta-analyses. No serious adverse effect has been reported to date, except for local hematoma
and minor bleeding at the puncture points. This technique can be a good option for clinicians who
are untrained in making TCM diagnoses and in acupuncture point selection.
Bronchial Asthma
There are many randomized controlled trials pointing to improved symptoms of asthma in children,
adolescents as well as adults, the improvement reaching statistical significance. A recently published
systematic review and meta-analysis included nine randomized controlled trials that compared
acupuncture plus conventional treatment with conventional treatment alone in adolescents and adults
with asthma (Jiang et al. 2019). Analysis of the pooled data from the nine trials showed statistically
significant improvement in symptoms response rate and a statistically significant reduction in
interleukin-6 levels in patients receiving combined acupuncture and conventional treatment than in
patients receiving conventional treatment alone; however, the analysis did not suggest improvement
in FEV1 and FEV1/FVC by addition of acupuncture in conventional treatment. In a systematic review
including seven randomized controlled trials evaluating the efficacy of acupuncture in asthmatic
children, beneficial effects on symptoms and lung function were reported by isolated trials, but no
conclusion could be made because of methodologic variability in the trials (Liu and Chien 2015).
Chronic Urticaria
Although several studies have shown global symptom improvement with the use of acupuncture in
patients with chronic urticaria, the overall quality of evidence for the effectiveness of acupuncture for
chronic urticaria is low. Two recent systematic reviews concluded that a combination of acupuncture
and antihistamines might be superior to antihistamines alone in the treatment of chronic urticaria,
but the risk of bias was high in all the randomized controlled trials included in the study (Yao et al.
2016; Yan et al. 2015).
SP10, ST36, LI11 and SP6 were the most common acupuncture points stimulated in most of these
trials. LI4, BL20, BL18 and GV11 were other common acupuncture points selected by the researchers
for stimulation. A recently published systematic review and meta-analysis of seven randomized
controlled trials evaluated auriculotherapy (auricular acupuncture, which uses only specific points on
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the auricle for stimulation) as a single intervention or in combination with other TCM interventions
in the treatment of chronic spontaneous urticaria (Zhu et al. 2018). The results of the meta-analysis
showed improved clinical features and safety of auriculotherapy, important limitations of the
meta-analysis were small sample sizes and methodological flaws in the included studies.
Atopic Dermatitis
Acupuncture is widely used in itchy dermatological conditions including atopic dermatitis. Several
case reports and small-sized studies suggest the beneficial effects of acupuncture in atopic dermatitis,
but the number of quality randomized controlled trials is very low (Tan et al. 2015; Shi et al. 2017).
In many of the studies, LI11 has been selected as an important “antipruritic acupuncture point” for
stimulation, in addition to other acupuncture points (Akpinar et al. 2018). The anti-pruritic effect of
acupuncture is known to occur due to a combination of both the peripheral and central mechanisms
(Akpinar et al. 2018).
Food Allergies
Scientific literature evaluating the effects of acupuncture in patients with food allergies is very
limited at present.
Adverse Effects of Acupuncture
One of the reasons why acupuncture is gaining popularity in patients with allergic disorders is
its safety and lack of serious adverse effects or long-term complications. Results of a systematic
review suggested that in patients with allergic rhinitis, acupuncture caused infrequent or negligible
adverse effects as compared to adverse effects caused by drugs (Lee et al. 2009). Common adverse
effects of acupuncture include pain at the site of needle insertion, minor local bleeding and local
hematoma. Minor bleeding can be easily controlled by applying pressure over the bleeding point
and hematoma usually subsides within one to three days. Because of the use of sterile, disposable
acupuncture needles, infection is a rarity. Syncope is a known adverse effect and usually occurs
immediately or several minutes after the first acupuncture treatment, especially when patients are in
a sitting or semi-recumbent posture (Xu et al. 2013). Depending upon the location of the needling,
injury to a local blood vessel, nerve or internal organ can occur; cases of pneumothorax and injury to
structures of the peripheral and central nervous system as well as internal organs have been reported
(Xu et al. 2013). However, avoidance of dangerous areas such as points in and around the orbit, side
and back of the neck, intercostal spaces and points on prominent blood vessels could prevent such
complications. Also, acupuncture is avoided on the nipple and breast, external genitalia, umbilicus
and scalp (if the fontanelle is not closed) (Lohiya and Lohiya 2014).
In addition to acupuncture, other TCM treatments, such as moxibustion, cupping therapy, herbal
application over acupuncture points, etc., are also used traditionally in the treatment of allergic
disorders; however, their description is beyond the scope of this chapter. Important herbs and herbal
formulations used in TCM for the treatment of allergic disorders are described under the heading of
herbal medicine.
Explanation of the selection of acupuncture points for any disorder requires knowledge of the
basics of TCM and is beyond the scope of this chapter. Acupuncture points that are commonly used
in the treatment of allergic disorders are described in Table 1 (Figure 2).
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Table 1. Commonly-used acupuncture points in the treatment of allergic disorders.
Acupuncture Point
(Name in TCM
Literature)
BL13 (Feishu) 1.5 cun
BL17 (Geshu) 1.5 cun lateral to the lower border of the
BL18 (Ganshu) 1.5 cun lateral to the lower border of the
BL20 (Pishu) 1.5 cun lateral to the lower border of the
BL12 (Fengmen) 1.5 cun lateral to the lower border of the
ST36 (Zusanli) 3 cun below the kneecap and one nger
SP6 (Sanyinjiao) 3 cun above the tip of the medial malleolus,
SP10 (Xuehai) 2 cun above the medial end of the upper
LI4 (Hegu) In the web between the index nger and
LI11 (Quchi) At the outer end of the elbow crease when
LI20 (Yingxiang) On the nasolabial grove, in the horizontal
LU1 (Zhongfu) In the infraclavicular fossa, 1.5 cun below
DU11 (GV11,
Shendao)
DU14 (GV14,
Dazhui)
RN4 (CV4,
Guanyuan)
Location Remarks
a
lateral to the lower border of the
spinous process of the third thoracic vertebra
spinous process of the seventh thoracic
vertebra
spinous process of the ninth thoracic vertebra
spinous process of the eleventh thoracic
vertebra
spinous process of the second thoracic
vertebra
breadth lateral to the lower end of the tibial
tuberosity
posterior to the border of the tibia
border of the patella
thumb on the dorsal aspect of the hand, at
top of the rst interosseous muscle when the
thumb is adducted
the elbow is semi-exed
line drawn from the outermost point of the
ala nasi
the midpoint of the clavicle
On the back, the midline between the
dorsal spines of the fth and sixth thoracic
vertebrae
On the back, the midline between the dorsal
spines of the seventh cervical and rst
thoracic vertebrae
3 cun below the umbilicus in the midline Used in the treatment of dry cough
(Relevant to Allergic Disorders Only, As Per
TCM Literature)
Used for treatment of disorders related to the
respiratory tract and skin
Used in the treatment of cough and dyspnea
Used in the treatment of urticaria
Used in the treatment of liver disorders and eye
disorders
Used in the treatment of muscle and tendon
disorders
Used in the treatment of digestive disorders and
allergic disorders
Used in the treatment of disorders related to the
respiratory tract
An important point for improving immunity
Used in several digestive disorders
Meeting point of three important meridians
Used in the treatment of allergy
Used in the treatment of digestive disorders
Used in the treatment of urticaria, atopic
dermatitis, allergic rhinitis and bronchial asthma
Used in the treatment of allergic rhinitis and
bronchial asthma
Used in the treatment urticaria and atopic dermatitis
Used in the treatment of allergic rhinitis and
bronchial asthma
Used for improving immunity
Used in the treatment of nasal congestion, allergic
rhinitis and sinusitis
Used in the treatment of cough, wheezing,
bronchitis, bronchial asthma and other disorders
of the lung
Dangerous point for acupuncture; pneumothorax
can be caused by deep insertion of the needle
Used in the treatment of cough, shortness of
breath, and shallow breathing
Meeting point of several important meridians
An important point for enhancing immunity
Used in the treatment of frequent colds, coughs,
bronchitis, and bronchial asthma
Used in the treatment of atopic dermatitis and
other skin disorders
Used in the treatment of diarrhea and indigestion
Table 1 contd. ...
...Table 1 contd.
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Role of Acupuncture in Allergic Disorders 347
Acupuncture Point
(Name in TCM
Literature)
RN8 (CV8,
Shenjue)
Ex1 (Yintang) Midway between the medial ends of the two
Ex17 (Dingchuan) 0.5 cun lateral to DU14 point Used in the treatment of bronchial asthma
Bitong
(Shangyingxiang)
(aCun – a traditional Chinese unit of length; 1 cun = width of the patient’s thumb at the interphalangeal joint).
Location Remarks
(Relevant to Allergic Disorders Only, As Per
TCM Literature)
In the center of the umbilicus Used in the treatment of diarrhea, abdominal
cramps, and borborygmi
This point is not used for acupuncture but
moxibustion and dry cupping can be done
Used in the treatment of allergic rhinitis and
eyebrows, on the ridge of the nose
Upper end of nasolabial groove, 0.5 cun
superior and lateral to LI20 point
sinusitis
Used in the treatment of nasal congestion and
allergic rhinitis
Figure 2.
Commonly used acupuncture points in treatment of allergic disorders (see Table 1 for description).
In the treatment of allergic disorders, acupuncture offers a novel mode of treatment with mechanisms
that are not addressed by conventional treatments. From the perspective of scientific research, it is
desirable that studies evaluating the efficacy of acupuncture in allergic disorders are conducted by
researchers who are trained in both modern medicine as well as in the basics of TCM. In experienced
hands, acupuncture is safe.
Role of Herbal Medicine in Allergic Disorders
Over the last three decades, use of herbal medicine has progressively increased in Western countries
as well. Out of many innumerable herbs traditionally used in the treatment of one or more allergic
disorders in different countries, a relatively small number of herbs have undergone scientific
evaluation and only a handful of them have shown conclusive evidence to support their use in
patients with allergies. Hence, only some common and important herbs and herbal formulations are
mentioned in Table 2.
Conclusion
Table 2. Commonly-used herbs and herbal formulations in allergic disorders.
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348 Textbook of Diagnostic and Therapeutic Procedures in Allergy
Herb/Herbal Formulation Mechanism of Action (Relevant to Allergic
Disorders)
Angelica sinensis (Angelica) Possible immunomodulatory and anti-
inammatory actions
Astragalus membranaceus (Astragali) Modulation of Th1 and Th2 cytokines A common Chinese herb used in the treatment of asthma Shergis et al. 2016; Amaral-
Berberine An alkaloid derived from
herbs of the Berberis genus
Curcuma longa (Turmeric) Contains the active compound curcumin,
Dianthus Superbus Reduction of peanut-specic IgE level Decreases anaphylaxis symptom scores in a murine model
Ginkgo biloba Anti-inammatory eects, inhibition of Th2
Glycyrrhiza uralensis (Licorice root) Contains active compounds glycyrrhizinic
Nigella sativa (black onion seed) Anti-inammatory, immunomodulatory, and
Inhibition of IgE production by suppression
of IgE isotype switching
Direct suppression of histamine release from
mast cells
which has anti-inammatory eects
Decreases Th2 cytokines and enhances Th1
cytokines
cytokines, inhibition of platelet-activating
factor
acid (anti-inammatory) and liquiritin
apioside (anti-tussive)
Inhibition of IgE production
antioxidant actions
Remarks References
A common Chinese herb used in the treatment of asthma Shergis et al. 2016; Amaral-
Machado et al. 2020
Machado et al. 2020
Used in the treatment of food allergy Wang et al. 2021
An add-on to conventional treatment in adults with asthma
- improves lung function
Has shown benecial eects in a murine model of food
allergy
of peanut-induced anaphylaxis
Improves lung function in asthma patients
Increased risk of bleeding in patients taking anti-coagulant
and anti-platelet drugs
A Chinese herb used in the treatment of asthma Shergis et al. 2016, Amaral-
Endonasal application of oil reduces symptoms of allergic
rhinitis. Reduces IgE and eosinophil count in nasal
discharge.
Amaral-Machado et al. 2020; Kohn
and Paudyal 2017; Shin et al. 2015
Wang and Li 2012
Shergis et al. 2016 ; Chu et al. 2011
Machado et al. 2020
Kozlov et al. 2018
Ingestion of oil in high dose can cause hepatic or renal
toxicity
Table 2 contd. ...
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Herb/Herbal Formulation Mechanism of Action (Relevant to Allergic
Disorders)
Perilla frutescens Contains luteolin that inhibits mucus
overproduction
Petasites hybridus (Butterbur) Inhibition of leukotriene synthesis An eective and one of the most promising herbs for the
Piper longum (long pepper) and Piper
nigrum (black pepper)
Radix Scutellariae Contains the active compound wogonin
Rubia cordifolia Reduction in peanut-specic IgE levels Has been shown to decrease anaphylaxis symptom scores
Sophora avescens Suppression of Th2 cells A Chinese herb used in the treatment of asthma Kohn and Paudyal 2016
Solanum xanthocarpum and Solanum
trilobatum
Tinospora cordifolia Anti-histamine and immunomodulatory
Tylophora indica Anti-inammatory, anti-histamine,
Both contain the active compound piperine
(inhibits eosinophil inltration and reduces
airway hyperresponsiveness)
Piper longum also contains piperlongumine
(inhibits the activity of multiple
inammatory mediators)
Inhibits production of interleukin 5 and
downregulation of expression of mediators
of allergic inammation
Possible bronchodilator eects Used in the treatment of asthma in the Siddha system of
eects
antioxidant, and anxiolytic eects
Remarks References
Extract enriched for rosmarinic acid has shown to improve
nasal symptoms and quality of life as well as to decrease
neutrophils and eosinophils in nasal lavage uid in patients
with allergic rhinitis
treatment of seasonal and perennial allergic rhinitis
Has been shown to decrease nasal resistance and reduce
inammatory mediator levels in nasal secretions
Used in the treatment of allergic rhinitis and asthma Amaral-Machado et al. 2020; Guo
A traditional Chinese herb used in the treatment of atopic
dermatitis
in the murine model of peanut-induced anaphylaxis
medicine
Extract from the herb has shown to improve symptoms of
allergic rhinitis and to decrease eosinophils, neutrophils,
and goblet cells in nasal smear
A commonly used herb in India for the treatment of asthma Rani et al. 2012
Guo et al. 2007 ; Kozlov et al. 2018
Guo et al. 2007; Kozlov et al. 2018 ;
Hoang et al. 2021
et al. 2007
Wang et al. 2021
Wang and Li 2012, Wang et al. 2021
Kohn and Paudyal 2016; AmaralMachado et al. 2020
Guo et al. 2007; Kozlov et al. 2018
Role of Acupuncture in Allergic Disorders 349
Zingiber ocinale Suppression of Th2-mediated immune
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ASHMI (antiasthma simplied herbal
medicine intervention)
FAHF-2 (Food Allergy Herbal
Formula-2)
Kakkonto Modulation of Th1 cells, enhanced inhibition
Pei Tu Qing Xin Tang Anti-histamine and anti-inammatory
Saiboku-to Anti-histamine, anti-inammatory and
responses
Inhibition of the production of eotaxin and
Th2 cytokines, inhibition of airway smooth
muscle contraction, increased brain-derived
neurotropic factor secretion
Inhibition of IgE production by human B
cells
interferon γ
Blockade of vascular leakage associated with
anaphylaxis
of Th2 cells, and enhancement of Treg cells
actions
Possible reduction of IgE production
anxiolytic eects
Used in the treatment of allergic rhinitis and asthma Kohn and Paudyal 2016; Kawamoto
A TCM formula containing three herbs
Has shown to improve lung function in adults with
moderate-to-severe persistent asthma
A TCM formula containing nine herbs
First USFDA botanical investigational new drug for food
allergy
Has shown safety and ecacy in murine models of peanut
allergy and multiple food allergies
Has shown safety in phase I and II clinical trials
Butanol-puried (B-FAHF-2) and enhanced B-FAHF-2
have also shown ecacy in murine models
A traditional Japanese medicine (Kampo) formula
containing seven herbs
Used in the treatment of food allergy
Has shown to suppress allergic diarrhea, decrease
mast cells in the intestinal mucosa and have favorable
immunological eects in the murine model
A TCM formula containing nine herbs
Has shown ecacy superior to topical corticosteroids in
the treatment of moderate-to-severe atopic dermatitis
A traditional Japanese medicine (Kampo) formula
containing ten herbs
et al. 2016
Kohn and Paudyal 2016
Wang et al 2021
Wang and Li 2012, Wang et al. 2021
Wang et al. 2021
Kohn and Paudyal 2016
350 Textbook of Diagnostic and Therapeutic Procedures in Allergy
Shi Zhen Tea Inhibition of the production of IgE, eotaxin,
and tumor necrosis factor α
Commonly used in the treatment of steroid-dependent
asthma
A TCM formula containing 4 dierent herbs
Used in the treatment of atopic dermatitis
Wang et al. 2021
Table 2 contd. ...
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Herb/Herbal Formulation Mechanism of Action (Relevant to Allergic
Disorders)
Sho-seiryu-to Possible immunomodulation, inhibition of
eosinophil inltration, and reduction of IgE
levels
Yu ping feng san Inhibits interleukin 1β, tumor necrosis factor
α, and interferon γ
Remarks References
A traditional Japanese medicine (Kampo) formula
containing 8 dierent herbs
Has shown to improve sneezing, running nose, and nasal
congestion in allergic rhinitis
A TCM formulation containing three herbs
Has shown benecial therapeutic eects in adults with
allergic rhinitis in more than 20 RCTs
Guo et al. 2007
Hoang et al. 2021
Role of Acupuncture in Allergic Disorders 351
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