Acupoint injection therapy for allergic rhinitis: a systematic review and meta-analysis with trial sequential analysis of randomized controlled trials

Zilu Wu^1,2Bin Zhao³Jiajun Huang⁴Yining Cai¹Qiong Fang¹Yumei Zhou^2*Ji Wang^2*

• ¹Henan University of Chinese Medicine, Zhengzhou, China
• ²Beijing University of Chinese Medicine Traditional Chinese Medicine Constitution and Reproductive Medicine Research Center, Beijing, China
• ³Henan University of Chinese Medicine Henan Provincial Hospital of TCM, Zhengzhou, China
• ⁴Shanghai University of Traditional Chinese Medicine, Shanghai, China

Background: Acupoint injection therapy integrates traditional Chinese and Western medical approaches and has emerged as a promising treatment for allergic rhinitis (AR). Although its use is increasing, comprehensive evidence summarizing its clinical outcomes remains limited. This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupoint injection therapy for the treatment of AR. The review was registered in PROSPERO (CRD42023445174) and conducted in accordance with PRISMA guidelines. Methods: Comprehensive searches were performed in PubMed, Web of Science, Embase, Cochrane Library, CNKI, Wanfang Data, Chongqing VIP, and CBM to identify eligible randomized controlled trials (RCTs). Two independent reviewers extracted data from eligible studies. The Cochrane Risk of Bias tool was used to assess study quality and potential bias. Pooled relative risk (RR) and 95% confidence intervals (CIs) were calculated to evaluate both efficacy and adverse events associated with acupoint injection therapy. Subgroup and sensitivity analyses were conducted to explore heterogeneity and test result robustness. Trial sequential analysis (TSA) was further applied to assess whether the cumulative evidence reached the required information size (RIS) for reliable conclusions. Results: 34 RCTs with moderate to high methodological quality were included in the analysis. Acupoint injection combined with conventional therapy significantly improved clinical efficacy compared with conventional therapy alone (RR = 1.18, 95% CI: 1.11-1.25). Acupoint injection therapy alone also demonstrated higher efficacy than conventional therapy (RR = 1.07, 95% CI: 1.00-1.15). No statistically significant difference in adverse event risk was observed between acupoint injection therapy and conventional treatment (RR = 1.39, 95% CI: 0.81-2.38). Sensitivity analyses confirmed the robustness of the primary results. TSA results indicated that the cumulative evidence for combined therapy was sufficient to support robust conclusions. Eligibility criteria were developed based on the PICOS framework (Population, Intervention, Comparator, Outcomes, and Study design). Conclusions: Both acupoint injection combined with conventional therapy and acupoint injection monotherapy significantly improve treatment efficacy in patients with AR. Importantly, neither therapy increases the risk of adverse events.