Clinical efficacy and safety of acupuncture in the treatment for chronic spontaneous urticaria: a systematic review and meta-analysis

Abstract

Objective: This study aims to systematically evaluate the clinical efficacy and safety of acupuncture in treatment for chronic spontaneous urticaria (CSU) and provide evidence to inform clinical decision-making.

Methods: A comprehensive search of eight Chinese and English databases was carried out. The search period spanned from the inception of the database up to 20 August 2024, and the search included randomized controlled trials (RCTs) on acupuncture for CSU, without language restrictions. Two independent researchers screened the resulting studies, evaluated their quality, and cross-checked their results. The extracted data were subjected to meta-analysis using RevMan 5.4 and Stata 15.

Results: A total of 22 RCTs involving 1,867 patients were included. Meta-analysis showed that acupuncture significantly improved the overall response rate, reduced the recurrence rate, decreased the urticaria activity score, and improved the Dermatology Life Quality Index, Hamilton Depression Scale, VAS itching score, and the Chronic Urticaria Quality of Life Questionnaire scores. Acupuncture also resulted in a reduced number and size of wheals, shortened duration of flare-ups, and reduced serum IgE, IFN-γ, and IL-4 levels. In addition, it led to significantly reduced traditional Chinese medicine syndrome scores, all with statistical significance. Furthermore, acupuncture did not significantly increase the incidence of adverse events, which indicates good safety. However, moderate to high bias and heterogeneity were observed in the included RCTs. Based on the Grading of Recommendations, Assessment, Development, and Evaluation evidence, this study provides a moderate to low recommendation for acupuncture in the treatment for CSU although the results remain promising.

Conclusion: Acupuncture appears to be an effective and safe treatment for CSU. However, further high-quality RCTs are needed to confirm its clinical efficacy and safety.

Keywords: acupuncture; chronic spontaneous urticaria; meta-analysis; systematic review; urticaria.

Figure 1

Flowchart of literature.

Figure 2

(A) Quality of detailed articles. (B) Quality of overall articles.

Figure 3

Forest plot of efficiency.

Figure 4

Funnel plot of efficiency.

Figure 5

Sensitivity analysis of efficiency.

Figure 6

Forest plot of subgroup analyses of the efficacy of different intervention methods.

Figure 7

Forest plots of subgroup analyses of efficacy across treatment cycles.

Figure 8

Forest plot of recurrence rates.

Figure 9

Forest plot of UAS7.

Figure 10

Forest plot of subgroup analyses of UAS7 of different intervention methods.

Figure 11

Forest plot of DLQI.

Figure 12

Forest plot of subgroup analyses of DLOI of different intervention methods.

Figure 13

Forest plot of CU-Q2oL.

Figure 14

Forest plot of the number of urticaria lesions.

Figure 15

Forest plot of degree of itchiness.

Figure 16

Forest plot of subgroup analyses of degree of itchiness of different intervention methods.

Figure 17

Forest plot of seizure duration.

Figure 18

Forest plot of IgE levels.

Figure 19

Forest plot of IFN-γ levels.

Figure 20

Forest plot of IL-4 levels.

Figure 21

Forest plot of TCM score.

Figure 22

Forest plot of security indicators.

Figure 23

Forest plot of subgroup analyses of security indicators of different intervention methods.