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Ear-acupressure for allergic rhinitis: A systematic review
Abstract
Allergic rhinitis affects 10-40% of the population globally with a substantial health and economic impact on the community.
To assess the effectiveness and safety of ear-acupuncture or ear-acupressure for the treatment of allergic rhinitis by reviewing randomised controlled trials and quasi-randomised controlled trials.
This review followed the methods specified in the Cochrane Handbook for Systematic Reviews of Interventions.
A total of 21 electronic English and Chinese databases were searched from their respective inceptions to April 2008. Key words used in the search included the combination of ear, auricular, acupuncture, acupressure, acupoint, allergic, allergy, rhinitis, hayfever, randomised clinical trial and their synonyms.
The methodological quality was assessed using Jadad's scale. The effect size analysis was performed to explore the difference between interventional groups.
Ninety-two research papers were identified and seven of them referring to five studies met the inclusion criteria. All included studies involved ear-acupressure treatment. These studies mentioned randomisation, but no details were given. None of the five studies used blinding or intention-to-treat analysis. Ear-acupressure was more effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term effect, but it was more effective than anti-histamine for long-term effect.
The benefit of ear-acupressure for symptomatic relief of allergic rhinitis is unknown due to the poor quality of included studies.
... Previous studies indicated that EAP could be effective and safe for AR. 13 However, there was insufficient evidence to confirm this. 13 Therefore, we conducted this international, multicenter, single-blinded, RCT to determine the efficacy and safety of EAP for PAR treatment. ...
... Previous studies indicated that EAP could be effective and safe for AR. 13 However, there was insufficient evidence to confirm this. 13 Therefore, we conducted this international, multicenter, single-blinded, RCT to determine the efficacy and safety of EAP for PAR treatment. ...
... Five ear acupoints were used for real EAP; these include shenmen (TF 4 ), internal nose (TG 4 ), lung (CO 14 ), wind stream (SF 1,2i ), and adrenal gland (TG 2p ). They were selected based on clinical trials, 13 Chinese medicine theory, 12 and consultation with experts. Five sham EAP acupoints are helix 2 (HX 10 ), shoulder (SF 4,5 ), clavicle (SF 6 ), OCCIPUT (AT 3 ), and tooth (LO 1 ). ...
Background:
Perennial allergic rhinitis (PAR) has a high and increasing prevalence worldwide. Ear acupressure (EAP) is a noninvasive semi-self-administered form of acupuncture. Previous studies indicated that EAP could be effective and safe for AR symptom management. However, there was insufficient evidence to confirm this. This study investigated whether EAP, a noninvasive clinical alternative to acupuncture, is effective and safe for PAR.
Methods:
This is an international, multicenter, randomized, single-blind, sham-controlled trial. The trial was conducted at two centers: Royal Melbourne Institute of Technology University (Melbourne, Australia) Clinical Trial Clinic and Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China. PAR participants were randomized to receive real or sham EAP treatment once a week for 8 weeks and then were followed-up for 12 weeks. Participants were instructed to administer EAP stimulation three times daily. Symptom severity and quality of life (QoL) were evaluated. Adverse events (AEs) were also monitored. Intention-to-treat analysis on change of symptom scores and QoL was applied.
Results:
Two hundred forty-five participants were randomly assigned to real (n = 124) and sham EAP (n = 121) groups. Twenty-five participants discontinued during treatment and 15 participants dropped out during follow-up. At the end of treatment and follow-up periods, changes of global QoL score were significantly greater in the real EAP group compared with the sham group. At the end of follow-up, scores for total nasal symptom, runny nose, and eye symptoms in the real EAP group had a greater reduction compared with the sham group. Overall, both real and sham EAP were well tolerated. Two severe AEs were reported but were not considered related to the EAP procedures.
Conclusion:
In conclusion, EAP showed short-term and extended benefit for improving PAR symptoms and QoL for PAR patients.
... Questions under the third part, the beliefs about AR characteristic and treatment options, were newly designed and developed by the researchers in order to indicate both groups of respondents' beliefs in each aspect. The questions were modified from previous studies about AR characteristic and treatment options [10,[16][17][18][19][20][21][22][23][24][25]. The questions consist of 2 parts. ...
... The result above shows that there are only a small group of people who believe that the acupressure massage can relieve AR symptoms. Two systematic reviews [24,25] in China conducted in 2008 and 2017 were presented. Nevertheless, both studies are found to have unreliable conclusion on account of and inefficient amount of available trials, high risk of bias, and poor quality of the sources. ...
Background:
Allergic rhinitis (AR) has substantially negative impacts on patients' quality of life. Besides conventional medicines, many patients use alternative approaches, which sometimes were misconception.
Objective:
This study aims to explore and compare the beliefs about AR and its treatment options between 2 different groups; control and AR patient groups.
Methods:
A cross-sectional study of 518 respondents residing in the central region of Thailand has been conducted using a self-reported questionnaire which consists of 3 parts; personal profile, the International Study of Asthma and Allergies in Childhood (ISAAC) questions, and the beliefs. ISAAC is applied for identifying respondents as the control or the AR group.
Results:
From a total of 518 respondents, 311 (60.0%) were identified as the AR group. The demographic data between the control and the AR group has no statistical difference (p > 0.05). Regarding the beliefs about AR characteristics, 56.1% of the AR group believe that low immunity causes AR while the number of the control group reaches 56%. Thirty-nine point two percent for the AR group and 38.6% for the control group believe that AR is a fatal disease. The belief that AR can be spread by droplet/airborne transmission is 22.8% and 28.5% for the AR and the control group, respectively. About AR treatment options, 60.1% of the AR group and 43% of the control group believe that taking vitamin C can relieve AR symptoms, which has a statistical difference (p < 0.05) between the 2 groups. The belief that prolonged use of antihistamine drugs can cause drug resistance is 29.9% and 24.6% for AR and control groups, respectively.
Conclusion:
Both groups of respondents mostly share common beliefs about AR characteristics and treatment options in which the AR group has higher percentage in some beliefs. Therefore, health literacy should be promoted in order to improve patient's care.
... The results of the present review were similar to those of previous reviews. 2,3,5,16,32 All of the previous systematic reviews included studies of acupressure performed by both participants and practitioners. ...
... 23 The results of a review of acupuncture and acupressure for allergic rhinitis by Zhang et al. were similar to those of the present study. 32 Inclusion criteria were not limited to self-administered acupressure or treatment by practitioner. Among the five included studies, three studies compared auricular acupressure with antihistamines or Chinese herbal medicine, and the symptom score for the auricular acupressure group was significantly improved in comparison with the control group. ...
To assess the efficacy and safety of self-administered acupressure to alleviate symptoms of various health problems, including allergic disease, cancer, respiratory disease, dysmenorrhea, perceived stress, insomnia, and sleep disturbances.
We searched core, Korean, Chinese, and Japanese databases, including Ovid-MEDLINE, Ovid-EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the Cumulative Index to Nursing and Allied Health Literature (CINAHL), six representative electronic Korean medical databases, China National Knowledge Infrastructure (CNKI), and Japan Science and Technology Information Aggregator (J-STAGE). We included randomized controlled trials (RCTs) and quasi-RCTs that examined disease-specific effects or symptom relief, adverse reactions, and quality-of-life (QOL) for self-administered acupressure. Data collection and assessment of the methodological quality of the included studies were conducted by two independent reviewers.
Eight RCTs and two quasi-RCTs showed positive effects and safety of self-acupressure therapy in clinically diverse populations. Quality assessment revealed moderate quality for the RCTs, with 50% or more of the trials assessed as presenting a low risk of bias in seven domains. All of the selected 10 studies reported positive effects for primary outcomes of self-acupressure therapy for symptom management, including significant improvements in symptom scores in allergic disease, nausea and vomiting in cancer, symptom scores in respiratory disease, pain symptoms in dysmenorrhea, and stress/fatigue scores and sleep disturbances in healthy people.
Our findings suggest that self-administered acupressure shows promise to alleviate the symptoms of various health problems. Therefore, further research with larger samples and methodologically well-designed RCTs is required to establish the efficacy of self-administered acupressure.
Copyright © 2014 Elsevier Ltd. All rights reserved.
... Other reviews evaluated acupressure's effectiveness for any condition, 10,12 dysmenorrhea, 16 and allergic rhinitis. 17 The methodological quality of the systematic reviews was generally poor. Only one review scored five points, four scored three points, and four scored one point. ...
... The other two systematic reviews relate to dysmenorrhea 16 and allergic rhinitis. 17 Both are of poor quality and both rely on a small number of flawed studies. It seems fair to say that the value of acupressure is not well documented for either of these conditions. ...
... TF4 is related to the psychological, nervous, and emotional systems of the body, so it can relieve anxiety, fear, anxiety, and help regulate the nervous system and prevent itching [21,22,23]. TG2p and CO18 have been reported to modulate humoral and nervous immunity, treat dermatitis, and also have anti-allergic functions [21,24]. Hence, these four acupoints including CO14, TF4, CO18, and TG2p can be recommended as priority choices for AD. ...
Background and Objectives: Adult eczema (AE) has been reported to have a poor quality of life (qoL). Auricular acupuncture (AA) is a method that has been studied a lot recently. Our study is to determine the effects of combining AA and modern medication in the relief of symptoms and the improvement in qoL in AE. Methods: A single-blind randomized study on 65 AE at the University Medical Center Ho Chi Minh City Branch 3; was randomized into an auricular acupuncture (AA) group and a Sham acupuncture (SA) group. All AA group patients will receive AA at Lung, Shenmen, Endocrine, and Adrenal points. The score of scoring atopic dermatitis (SCORAD) and the score of dermatology life quality index (DLQI) were compared in two groups before and after treatments. Results: There were 33 patients in the AA group and 32 patients in the SA group. After 2 weeks, in the SA group, the SCORAD score of 46.4 ± 1.3 decreased to 28.2 ± 1.2, compared with the AA group’s SCORAD score of 47.5 ± 1.5 decreased to 24 ± 1.3; the DLQI score of 14.7 decreased to 7.6, compared with the intervention group DLQI score of 15, reduced to 5.7. The difference in improving the SCORAD score and the DLQI score between the two groups was statistically significant. No patient had any adverse events during the study. Conclusions: Combining auricular acupuncture Lung, Shenmen, Endocrine, Adrenal points, and modern medication treatment may relieve effectively symptoms and improve the QoL in AE.
... They are selected on the basis of traditional Chinese medicine theory, previous clinical research, and expert consultation. [16,20] Five sham EAP acupoints are helix 2 (HX 10 ), shoulder (SF 4,5 ), clavicle (SF 6 ), OCCIPUT (AT 3 ), and tooth (LO 1 ). These acupoints have no effect on the relief of allergies or any nasal symptoms. ...
Background:
Allergic rhinitis is a global problem. About 10% to 40% of the global population is affected by allergic rhinitis and is on the rise, which has a significant health and economic impact on society. Ear acupuncture is a non-invasive acupuncture therapy, which has been used in the treatment of allergic rhinitis, and some positive results have been reported, but there is not enough evidence to prove its efficacy and safety.
Methods:
This is a single-center, randomized, single-blind, sham-controlled trial. With the approval of the ethics committee of our hospital, participants with allergic rhinitis will be randomly assigned to receive either real or sham ear acupuncture once a week for 8 weeks, followed by 12 weeks of follow-up. Evaluate the patient's nasal symptom score and Standardised Rhinoconjunctivitis Quality of Life Questionnaire score, and monitor adverse events. Finally, the data are analyzed by SPSS 22.0 software.
Discussion:
The results of this study will determine the efficacy and safety of ear acupuncture in the treatment of allergic rhinitis and provide a basis for promoting the application of ear acupuncture in the treatment of allergic rhinitis.
Trial registration:
OSF Registration number: DOI 10.17605/OSF.IO/MVEF7.
... In the recent past, an increasing number and size of random controlled trials (RCTs) for AR have been conducted with several systematic reviews [20,21,[30][31][32][33], confirming the efficacy and safety of acupuncture. However, these studies have only focused on a single acupuncture therapy against a control treatment for AR. ...
Background
Allergic rhinitis (AR) is a common symptomatic, inflammatory, and immunological disorder of nasal mucosa. Multiple clinical trials and systematic reviews have implicated acupuncture methods as potentially effective treatment strategies for AR, however, considering the great burden of AR, it is crucial to explore the most recent clinical evidence supporting acupuncture in AR. Besides, the methodologies reported in previous studies as well as those commonly applied during clinical practices greatly vary. Herein, we conducted network meta-analysis to compare the effectiveness of diverse acupuncture methods for AR treatment.
Methods
We conducted a literature search for relevant reports published from inception to 1 July 2020 in several scientific databases, including PubMed, Embase, Cochrane library, Web of Science, CNKI, WF, VIP, CBM, AMED as well as related registration platforms. Primary outcomes as reported in the identified studies were assessed using nasal symptoms. All Meta-analyses were performed with RevMan, ADDIS, and STATA software. To ensure consistency among our reviewers, the intra-class correlation coefficient was used.
Results
Exactly 39 studies with 3433 participants were covered in this meta-analysis. The meta-analysis demonstrated that all acupuncture types were superior to sham acupuncture in terms of total nasal symptom score and rhinoconjunctivitis quality of life questionnaire. Moxibustion was recommended as the most effective intervention as it reduced nasal symptoms in 6 treatments. On the other hand, manual acupuncture plus conventional medicine was recommended as the most effective intervention in improving the quality of life in 9 treatments. Notably, moxibustion was recommended as the most effective intervention that changed the content of IgE in 9 treatments. Moreover, adverse events of these interventions were acceptable.
Conclusion
Our findings revealed that all acupuncture methods are effective and safe for AR. Moreover, either moxibustion or manual acupuncture plus conventional medicine are potentially the most effective treatment strategies for AR. Based on these findings, it is evident that acupuncture therapy is not inferior to pharmacologic therapy. Therefore, for AR patients who are either unresponsive to conventional medicine or are intolerant to adverse events, acupuncture therapy should be administered. However, the quality of these included trials was mainly ranked as moderate quality, we recommend additional well-designed RCTs with larger sample sizes to validate these findings.
... In reviews for adult constipation [42] and prevention of chemotherapy-induced constipation in leukemia patients [39], AP provided benefit when added to routine care. For treatment of allergic rhinitis, AP was as effective as antihistamines and was considered promising [44]. Most reviews call for ongoing research in larger well-designed trials to clarify results and recommendations and to explore protocols of points and ideal timing, frequency, and duration of intervention. ...
Objective:
Auricular acupuncture (AA) and extended auricular therapy (AT) are a part of acupuncture practice shown to benefit patients with pain, anxiety, and other conditions, with cost-effective access enhanced when given in a group setting. Yet there are safety concerns and risks, perhaps unnecessary risks, that attend embedded, indwelling needles applied to the ear as a means of extended AT.
Methods:
Electronic searches were conducted in PubMed, MEDLINE, CINAHL and Cochrane Central Register of Controlled Trials (CENTRAL) for "auriculotherapy," "auricular acupuncture" or "auricular acupressure," "safety," "adverse events," "chondritis," and "perichondritis," with additional manual review of titles, links, and reference lists. Individual auricular therapy adverse event (AE) case reports were included, as well as systematic reviews and or meta-analyses if they evaluated AEs associated with AT.
Results:
Nineteen auricular AE case reports and nine safety reviews of or including auriculotherapy were included. Ten systematic reviews of AT with eight specific reviews of auricular acupressure (AP) were also included.
Conclusions:
The primary AE risks is infection, perichondritis, and chondritis stemming from embedded or indwelling needles or potential inadvertent needlesticks from contaminated roaming sharps. Extended AP i.e., application of spheres, preferably seeds (natural, nontoxic botanical Vaccaria seeds) provides clinical benefit without the risks associated with embedded needles. More research is needed to establish if embedded needles at the ear are even necessary or have any advantage over in-session auricular acupuncture for immediate pain relief followed by ear acupressure.
... The use of filiform needles, (7)(8)(9)(10)(11)(12)(13)(14)(15) application of cataplasm on acupoints, (16)(17)(18)(19)(20)(21)(22)(23)(24) moxibustion, (25)(26)(27)(28)(29)(30) auricular seeds method, (31)(32)(33)(34) and acupoint injection (35,36) Table 2. ...
With reference to international guidelines for the development of tools—Grading of Recommendations Assessment, Development and Evaluation (GRADE) system approach and reasoning, this practice guideline has been drafted reflecting the characteristics of acupuncture to improve effectiveness and safety of acupuncture treatment for allergic rhinitis. This guideline includes outlining the acupuncture diagnosis and treatment principles for allergic rhinitis, suggesting recommendations and related evidence for the acupuncture treatment of allergic rhinitis, and defining operating methods and precautions for the acupuncture treatment of allergic rhinitis.
... Lung (CO14) also works on relieving painful and itchy skin diseases [36]. Endocrine (CO18) and Pizhixia (AT4) could be helpful with endocrine hormone balance, hypersensitivity, and rheumatism [37,38]. After sterilization with 75% alcohol, Vaccaria seeds will be stuck and fixed on the above auricular points of both ears, with each pressed individually for 1 min to induce stimulus until patients feel endurable heat and distending pain on the auricles, and patients are advised to repeat the pressing themselves four times daily for 5 consecutive days and then to remove the seeds stuck to their auricles on the morning of day 6, which is helpful to avoid contact dermatitis caused by long-term adhesive tape. ...
Introduction:
Psoriasis vulgaris is a common skin disease characterized by persistent localized erythematous scaly plaques, typically on the elbows, knees, and scalp. It is an immune-abnormal disease that progresses slowly over a long period with frequent symptom recurrence. Current studies have shown that acupuncture is an effective therapy for psoriasis. However, the scientific evidence of the efficacy of auricular acupressure treatment for patients with psoriasis is still insufficient. Therefore, we designed a randomized controlled clinical trial to investigate the effect, safety, and cost-effectiveness of auricular acupressure in addition to medication in patients with psoriasis.
Methods and analysis:
This on-going study is a two-arm parallel, assessor-blinded, randomized controlled trial in which 180 participants with psoriasis will be recruited and then randomly allocated into two groups in a 1:1 ratio. Equal randomization will be conducted using a computer-generated random allocation sequence. Participants in the intervention group will receive auricular acupressure treatment once per week for 4 weeks, and calcipotriol betamethasone ointment for topical use once daily for 4 weeks. Participants in the control group will receive only calcipotriol betamethasone ointment treatment once daily for 4 weeks. All patients will be followed up for 12 weeks. The primary outcome is relapse rate. The secondary outcomes include time to relapse, rebound rate, time to new onset, Psoriasis Area and Severity Index score improvement rate, body surface area affected, a visual analogue scale, and Dermatology Life Quality Index. Cost-effectiveness analysis will be carried out from a health and community care provider perspective.
Discussion:
This multicenter randomized controlled trial will provide important clinical evidence for the effect and safety of auricular acupressure as a complementary therapy in patients with psoriasis.
Trial registration:
Chinese Clinical Trial Registry, ChiCTR-TRC-14004916 . Registered on 20 May 2014. This protocol is version 3.0 which was updated on 24 September 2016.
... In the Immunology field, specifically in the treatment of allergic rhinitis, 2 studies (n = 508) showed that auriculotherapy has a significantly higher short-term effect (4 weeks) when compared to Chinese herbal medicine, and significantly better long-term effect (6 months) than anti-histamine medication in 1 study (n = 150) but not than body acupuncture or anti-histamine (cetirizine) in a 4 weeks [33]. Regarding the Gastroenterology field, one review with 15 studies (n = 1324) points towards improvements in constipation, however no effects over other symptoms associated with this disorder (e.g., abdominal distension) [32]. ...
Background and purpose
Auriculotherapy is a therapeutic technique used for a wide variety of conditions. Nevertheless, similarly to any health related intervention, the clinical use of this therapy requires scientific evidence of effectiveness in order to support its rational use. The main goal of this article is to critically analyze published literature on auriculotherapy and to provide an overview of the effectiveness of this technique in the management of health disorders.
Methods
The inventory of published reviews on this subject was carried out in November 2017, by assessing the following computerized databases: PubMed, MEDLINE, PsycINFO, EBMR, Cochrane Database of Systematic Reviews, CINAHL Plus NRC and Science Direct. Were only considered the systematic reviews based on meta-analysis with high methodological quality described according to AMSTAR (Assessment of Multiple Systematic Reviews). The eligible articles were systematically reviewed to find out in which health conditions auriculotherapy can be used with effectiveness.
Results
A total of 14 reviews were eligible according to the inclusion and exclusion criterions. Those reviews were focused on the management of insomnia, smoking cessation and pain, within the clinical scope of Neurology, Orthopaedics and Rheumatology.
Conclusions
Auriculotherapy has shown to have positive effects while associated to conventional treatments of insomnia, chronic and acute pain. Further well designed studies are required to evaluate the effectiveness of this technique in the treatment of other health conditions.
... Although one participant dropped out for discomfort with the ear pellets, AEs were all mild or moderate. Previous studies that employed a similar EAP protocol for persistent allergic rhinitis [22,34] and smoking cessation [4,17] found that EAP was well tolerated by participants. ...
This study investigated the efficacy and safety of ear acupressure (EAP) as a stand-alone intervention for smoking cessation and the feasibility of this study design. Adult smokers were randomised to receive EAP specific for smoking cessation (SSEAP) or a nonspecific EAP (NSEAP) intervention which is not typically used for smoking cessation. Participants received 8 weekly treatments and were requested to press the five pellets taped to one ear at least three times daily. Participants were followed up for three months. Primary outcome measures were a 7-day point-prevalence cessation rate confirmed by exhaled carbon monoxide and relief of nicotine withdrawal symptoms (NWS). Intention-to-treat analysis was applied. Forty-three adult smokers were randomly assigned to SSEAP (n=20) or NSEAP (n=23) groups. The dropout rate was high with 19 participants completing the treatments and 12 remaining at followup. One participant from the SSEAP group had confirmed cessation at week 8 and end of followup (5%), but there was no difference between groups for confirmed cessation or NWS. Adverse events were few and minor.
... Kulak akupunkturu uygulaması da, allerjik rinit hstalarında uygulanmış bir alternatif tedavi yöntemidir. İnsomnia, obezite, ağrı tedavisinde kullanılan bu yöntem, kulakta bulunan "aku" noktalarının, metal yada bitki tohumları ile düzenli bir şekilde uyarılması şeklinde yapılır Allerjik rinitli hastalarda kulak akupunkturu tedavisinin etkisinin araştırıldığı 21 çalışmanın meta analizi sonucunda, diğer pek çok akupunktur ile ilgili çalışmalarda olduğu gibi, çalışmaların metodolojik olarak yeterli olmamaları nedeniyle sağlıklı fikir verici olmadıkları sonucuna ulaşılmıştır (40). ...
Acupuncture has an historical significance and currently its’ use and esteem are growing in modern medicine. Acupuncture points, or acu points are specific foci along lineer meridians or channels on skin surface. Recently, they are stimulated with needles, ultrasound, palpation, light and electric resistance. Acupuncture is based on influencing of acu points. However there is no standard definition or clinical approach to acupuncture. Needling techniques and forms of stimulation vary widely across patients and practitioners. During the last 50 years, acupuncture techniques have been put into practice in different regions of the world by most medical specialties, including allergic diseases. In this review, effects of acupuncture on immune system, and the possible mechanisms in allergic diseases are discussed. According to published data, effectiveness of acupuncture in allergic diseases seems to be related with the activation of hypothalamic-pituitary-adrenal axis, which is resulted in increased steroid production. Evidence from large randomised trials, including follow-up measurements of markers of inflammation, could be obtained to prove the immunologic effects of acupuncture. [TAF Prev Med Bull 2011; 10(1.000): 107-114]
... Stimulating a particular acupoint with acupressure can activate small myelinated nerve fibers that send impulses into the spinal cord, midbrain, pituitary, and hypothalamus26. AA, a treatment method derived from acupressure and ear acupuncture, is a safer, more effective, economic and simple approach362728293031. The practical advantages of AA include3233: (1) only minimal equipment is needed and any physicians or nurses can perform this treatment; (2) physicians as well as other health care providers who have rare or no experience in traditional Chinese medicine can learn this technique within a few hours and can use it whenever indicated; (3) it is almost a “no-cost” intervention; (4) AA is non-invasive and does not affect the integrity of the epidermis. ...
The study was to explore whether auricular acupressure (AA) can relieve anxiety during the period from trans-vaginal oocyte retrieval to the embryo transfer in IVF treatment and whether AA can improve the outcomes of IVF. 305 infertile patients with tubal blockage who were referred for IVF were included. The women were randomized into a control group with 102 cases, a Sham-AA group with 102 cases and an AA group with 101 cases. The anxiety levels were rated with Spielberger's State Trait Anxiety Inventory and the Amsterdam Preoperative Anxiety and Information Scale. Data of clinical pregnancy rate (CPR), implantation rate (IR) and live birth rate (LBR) were obtained. The levels of neuropeptide Y (NPY) and transforming growth factor alpha (TGF-alpha) in the follicular fluids were detected with ELISA. After treatment, in AA group, the levels of state anxiety, preoperative anxiety and need-for-information were significantly lower, whereas CPR, IR, LBR and NPY levels in the follicular fluids were markedly higher than Sham-AA group and control group. We concluded that AA could help to reduce anxiety levels associated with IVF and improves the outcomes of IVF partly through increasing the levels of NPY in the follicular fluids.
... Although one participant dropped out for discomfort with the ear pellets, AEs were all mild or moderate. Previous studies that employed a similar EAP protocol for persistent allergic rhinitis [22,34] and smoking cessation [4,17] found that EAP was well tolerated by participants. ...
Background:
Smoking is the largest preventable cause of death and disease worldwide but smokers often fail to quit due to nicotine withdrawal symptoms. Current available pharmaceutical therapies may assist with smoking cessation but may have side effects. Ear acupressure (EAP) and ear acupuncture have been used for smoking cessation, and some positive results have been reported. The aim of the study is to assess the efficacy and safety of EAP in assisting individuals to quit smoking and/or support them in the management of nicotine withdrawal symptoms.
Methods:
This study will be a randomised, single-blind, sham-controlled study conducted at RMIT University in Melbourne, Australia. Adult smokers will be randomly assigned to receive EAP specifically for smoking cessation or nonspecific EAP treatments. After a 2-week run-in, participants will be treated once a week for 8 weeks and followed up for 12 weeks. The primary outcome measures will be 7 day point-prevalence cessation rate by self-report validated by expired carbon monoxide and nicotine withdrawal symptoms measured by the Mood and Physical Symptoms Score questionnaire. Secondary outcomes will be self-reported usage of nicotine replacement therapies, cigarette consumption, body weight change and quality of life. The safety end point will be self-reported adverse events associated with EAP. Intention-to-treat analysis will be applied.
Discussion:
Findings from this study will determine if this EAP intervention alone can be an effective and safe therapy to assist with smoking cessation and the management of nicotine withdrawal symptoms.
... But it was more effective than anti-histamine for longterm effect. However, the benefit of ear-acupressure for systematic relief of AR is unknown due to the poor quality of included studies (Zhang, et al., 2010). Allergic symptoms are largely dependent on oxygen radical formation, which were found to be suppressed after red light illumination. ...
An updated edition of the International Consensus Statement on Allergy and Rhinology: Allergic Rhinitis (ICAR:AR) has recently been published. This consensus document, which included the participation of 87 primary authors and 40 additional consultant authors, who critically appraised evidence on 144 individual topics concerning allergic rhinitis, provides guidance for health care providers using the evidence-based review with recommendations (EBRR) methodology. This synopsis highlights topical areas including pathophysiology, epidemiology, disease burden, risk and protective factors, evaluation and diagnosis, aeroallergen avoidance and environmental controls, single and combination pharmacotherapy options, allergen immunotherapy (subcutaneous, sublingual, rush, cluster), pediatric considerations, alternative and emerging therapies, and unmet needs. Based on the EBRR methodology, ICAR:AR includes strong recommendations for the treatment of allergic rhinitis: (1) for the use of newer generation antihistamines compared with first-generation alternatives, intranasal corticosteroid, intranasal saline, combination therapy with intranasal corticosteroid plus intranasal antihistamine for patients not responding to monotherapy, and subcutaneous immunotherapy and sublingual tablet immunotherapy in properly selected patients; (2) against the use of oral decongestant monotherapy and routine use of oral corticosteroids.
The purpose of this study was to examine the correlation between auricular tenderness and subjective symptoms. A descriptive correlational study design was followed, which was also the second analysis of a randomized controlled trial. This study was performed in the Republic of Korea from September 2013 to February 2017. The Patient Health Questionnaire-9, the Constipation Assessment Scale, and the Nicotine Dependence Syndrome Scale were used. One hundred thirty-three participants displayed ear tenderness, whereas 84 participants did not. Adults with auricular tenderness reported more symptoms, such as sputum, rhinitis, constipation, stress, mood swings, and depressive symptoms compared with adults without (with tenderness: 4.14 ± 2.94, without tenderness: 2.92 ± 2.45; t = 3.32, P = .001). Finally, auricular acupressure points were positively correlated with various symptoms such as sputum, constipation, nicotine addiction, stress, cough, and rhinitis. Auricular palpation could be used to detect a disease at an early stage.
This chapter explores the issue of informing patients of choices between conventional medicine and Complementary and Alternative Medicine (CAM). “Practitioners” are categorized into three types: orthodox (conventional) medicine practitioners, dual practitioners and CAM practitioners. It is noted that the current law involving CAM and conventional medicine disclosure seems to be conventional-medicine-reinforcing. The chapter concludes with a call for both conventional medicine practitioners and CAM practitioners to provide their patients with unbiased and contextualised information that overcomes the boundaries of their “schools” of medicine. An “integrated” model, where all practitioners provide patients with contextualised information about divergent schools of thought, is better than a “fragmented” model, where every practitioner presents patients with information only about his “school” of thought, leaving patients to search for information about other “schools” of thought themselves.
Objective:
To assess the effectiveness of acupuncture for the treatment of functional constipation
(FC).
Methods:
The literature was searched for randomized controlled trials (RCTs) comparing acupuncture
with medical treatment; no medical treatment, placebo acupuncture, and sham acupuncture in patients
with FC were searched. Data were extracted by two independent reviewers using standard data
extraction forms. Risk of bias for each RCT was assessed using a modified Oxford 5-point quality
scale. Data were pooled according to intervention and treatment course. Parameters evaluated included
effectiveness/invalidity, Cleveland Clinic score (CCS), colon transit time (CTT) and adverse effects.
Results:
Nineteen studies involving 1679 participants were eligible for inclusion; of these studies,
16 were published in Chinese and three in English. Risks of bias were high. Acupuncture was significantly
superior to medication therapy in short-term (effectiveness/invalidity, P = 0.0009; CCS, P = 0.02)
and long-term (effectiveness/invalidity, P = 0.004; CCS, P = 0.04; CCT, P < 0.0001) effectiveness. A
short treatment course of less than 15 days was sufficient. The likelihood of adverse effects was significantly
lower for acupuncture than for medication therapy (P = 0.002).
Conclusion:
Compared with medication, acupuncture was more effective and had a lower adverse
effect rate in the treatment of FC. A short treatment course of two weeks was sufficient for a
good effect. However, the poor quality of the included trials indicates the need for well-designed
RCTs, including adequate sample size and a reasonable placebo control, to assess the effectiveness of
acupuncture for FC.
Since time immemorial, complementary and alternative medicines (CAM) have played a significant role in human health care. CAM is known to have a strong reputation and reliability within every culture to provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being for treating various diseases and improving quality of life with apt consideration to the economic aspects. Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other body parts. This review outlines various types, devices and mechanisms involved in the acupressure treatment.
This is the protocol for a review and there is no abstract. The objectives are as follows: To systematically evaluate the effects of acupuncture for treating allergic rhinitis. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
The accurate State of Charge (SOC) estimation in a Li-ion battery requires a suitable model of the cell behavior. In this work an enhanced closed loop estimator based on Extended Kalman Filter (EKF) is proposed, considering a precise model of the cell dynamics valid for different current profiles and SOCs, and a complete model of the Open Circuit Voltage (OCV) which takes into account the hysteresis influence. The employed model and proposed estimator are validated with experimental results obtained from the response of a 40 Ah NMC Li-ion cell to several current profiles. These tests include current pulses, FUDS driving cycles, residential lift profiles, and specially designed profiles which demand an accurate modeling of the transitions between OCV boundaries. In each case, it is demonstrated that the enhanced model can reduce the estimation error nearly by half compared to an estimator ignoring the hysteresis effect. Furthermore, the good performance of the cell dynamics model allows an accurate and stable estimation over different conditions.
Objectives The purpose of this study is to investigate recent clinical studies on effect of acupuncture for rhinitis in other countries. We have analyzed the studies on effect of acupuncture for rhinitis within randomized controlled trial(RCT), reviewed for 11 years (from 2001 to 2011). Methods The search database includes PubMed. To narrow the search, the following key search terms were used: `rhinitis, acupuncture`. The search was limited to the publication date from 2001 to 2011. Results Total 20 studies were selected: RCT(13), review(5), case report(1), and cost effectiveness study(1). In RCT, 9 studies used acupuncture only, and 8 studies of them have revealed that acupuncture is effective on rhinitis. In review, 3 studies are systematic review, 2 studies are no systematic review. Among systematic review, 2 studies have revealed partial effectiveness of acupuncture for rhinitis, but they suggested the necessity of further studies. Conclusions Domestic studies on effect of acupuncture for rhinitis are necessary. For more accurate results, controlled, large scale and well designed studies are recommended.
Objectives: In this study, we examined the effect of botulinum toxin A (BTA) on chronic allergic rhinitis (CAR). We tested the effects of BTA, applied to an intranasal sponge, on patients who had CAR for a minimum of three years and had been treated unsuccessfully with conventional medications.
Methods:The study was an interventional case-control single-blind randomized clinical trial. Forty-four male and female CAR patients who were referred to Tehran’s Saee & Pasargad Hospitals, and Saadat-Abaad, Sarv and Karimkhan Clinics in 2012 aged 20-40 years were selected on the basis of inclusion and exclusion criteria. The subjects were randomly assigned to the intervention (n=22) or control group (n=22). The intervention group received BTA (100 IU/ml Dysport), on a 5cm nasal sponge retained in each nasal cavity for 30 minutes. The control group received normal saline. The groups were evaluated by the same examiner. Pre-and post-tests (1, 3, 6, and 12 weeks) were performed according to the authors’ pre-designed checklist, the validity and reliability of which was previously established. The symptoms scored from none (0) to severe (10) at the test points. The statistical analysis was conducted with SPSS-19, with a significance level of 0.05.
Results: Based on ANOVA, there was a significant difference (P
Allergic rhinitis (AR) is a global disease affecting hundreds of millions internationally. Substantial pharmacologic gains have been made in the treatment of allergy, including antihistamines, steroids, and leukotriene inhibitors. Pharmacology and immunotherapy are the 2 primary choices in an otolaryngologist's armamentarium of allergy treatment. Outside of these options lie complementary and integrative medicine, including various herbs and supplementation along with acupuncture. Some of these methods have shown great efficacy in treating AR and others have failed to show any improvement. This article reviews AR and some of the more common therapies used to care for the disease.
The algorithm and recommendations provided here can help you take an evidence-based approach to your patient's allergic rhinitis.
In Australia, allergic rhinitis or 'hay fever' is a common long-term condition among the old and young. Its preva-lence in the adult population increased from 13.9% in 1995 to 16.1% in 2004 to 2005. 1 Allergic rhinitis impacts on patients' quality of life, work and school performance and on their productivity. 2 Therefore, allergic rhinitis represents a significant economic burden to individuals and the commu-nity. 3 Moreover, it is associated with several comorbidities, including asthma, sinusitis and conjunctivitis. 4,5 Patients with allergic rhinitis frequently self-medicate and may use a range of over-the-counter products and herbal medi-cines, 6 as well as having acupuncture performed. In Australia, acupuncture is one of the most commonly used forms of com-plementary therapies. 7 In 2005, about one in 10 (9.2%) adult Australians had acupuncture performed and more than 10.2 million acupuncture consultations were conducted by medical and nonmedical practitioners. 8 Nationwide, Medicare provided more than $83 million in acupuncture rebates between 2006 and 2010. 9 Acupuncture and ear acupressure may provide some relief for patients with allergic rhinitis but more trials are needed to provide the evidence needed to support this treatment.
To explore the therapeutic effect of auricular therapy combined with optimized Yinxieling Formula on psoriasis vulgaris.
A randomized controlled single-blind clinical trial on 84 outpatients with psoriasis vulgaris was conducted. The patients were randomized to a treatment group (43 cases treated by auricular therapy combined with optimized Yinxieling Formula) and a control group (41 cases treated by optimized Yinxieling Formula alone) according to a random number generated by SPSS 17.0 software. The treatment duration for both groups was 8 weeks. The therapeutic effect was comprehensively measured by the primary outcome measure [Psoriasis Area and Severity Index (PASI) reduction rate] and the secondary outcome measure [PASI, Visual Analogue Scale (VAS), Dermatology Life Quality Index (DLQI), Self-rating Depression Scale (SDS), and Self-rating Anxiety Scale (SAS)]. The outcomes of both groups were obtained and compared before and after the intervention.
The PASI reduction rate in the treatment group was 74.4% (32/43), which was higher than that in the control group (36.6%, 15/41, P<0.01). The PASI scores decreased in both groups after treatment and was lower in the treatment group compared with the control group P<0.01). With stratified analysis, there were significant differences between the PASI scores in the following subgroups: age 18-30, baseline PASI>10 and stable stage (P<0.05). DLQI decreased in both groups on some categories after treatment, but there were no significant differences between the two groups in SDS, SAS and VAS (P >0.05). No obvious adverse reactions were found in either group.
The therapeutic effect of auricular therapy combined with Optimized Yinxieling Formula was superior to Optimized Yinxieling Formula alone with no obvious adverse reaction.
With the arrival of the era of global population aging, we strive for healthy aging and a healthy senior life rather than simple prolongation of the physical age. For the past 50 years, cardiovascular diseases (CVD) have been the most common cause of death among the elderly people globally. In China, there has been an exponential increase in the incidence of heart disease and stroke in the elderly population. Atherosclerosis is the pathological change in the coronary artery disease, stroke, and peripheral vascular disease. Despite the significant benefit demonstrated, control of classic risk factors alone, such as lifestyle change or drug therapy, was shown to have limitations in reducing the incidence of cardiovascular events. Vascular aging has been shown to be an important independent predictor of CVD events. Interventions targeting vascular aging have emerged as a new paradigm in conjunction with control of risk factors for the prevention of CVD. Vascular aging and atherosclerosis are two distinct pathological changes and difficult to distinguish clinically. Recent research with Chinese medicine (CM) has shown encouraging observations, linking the clinical benefit of delaying vascular aging and treating atherosclerosis. These results demonstrate great potential of CM in the prevention and treatment of CVD.
The Brassicaceae family encompasses numerous species of great agronomic importance, belonging to such genera as Brassica, Raphanus, Sinapis, and Annoracia.1 Raphanus sativus is a perennial plant that belongs to the Brassicaceae family, and it is native to China and Japan. The radish is eaten raw; the bulbs and the leafs are edibles and are used for the preparation of salads in some Mediterranean areas. The R sativus bulb is spherical and red and has white pulp, with a pungent flavor and lobed leafs with irregular edges. The literature reports reactions to Raphanus niger, which is considered a variety of R sativus.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
The clinical efficacy and safety of acupuncture in the treatment of Seasonal Allergic Rhinitis (SAR) was evaluated by employing a two-phase crossover single-blind clinical trial. Thirty subjects were randomly assigned to two groups with 17 and 13 subjects respectively and treated with real or sham acupuncture (three times per week) for four consecutive weeks and then a crossover for treatments for a further four weeks without a washout period. The administration of real acupuncture treatment was guided by a syndrome differentiation according to Chinese Medicine Theory. Subjects were assessed by various criteria before, during and after the treatments. Outcome measures included subjective symptom scores using a five-point scale (FPS), relief medication scores (RMS) and adverse effect records. Twenty-six (26) subjects completed the study. There was a significant improvement in FPS (nasal and non-nasal symptoms) between the two types of acupuncture treatments. No significant differences were shown in RMS between the real acupuncture treatment group and the sham acupuncture treatment group. No side effects were observed for both groups. The results indicate that acupuncture is an effective and safe alternative treatment for the management of SAR.
The purpose of this study was to evaluate the cost of illness of moderate-to-severe atopic asthma and/or seasonal allergic rhinitis (SAR) in Germany from the perspective of third-party payers (TPP) and patients.
Five-hundred patients (276 children/adolescents) with moderate-to-severe asthma and/or SAR were included in this cross-sectional study. Information was collected using a specific patient questionnaire and the abstraction of patient records.
Overall, annual costs per patient increased with the severity of atopic asthma and if it was associated with SAR. The average annual cost of SAR was 1,089 per child/adolescent and 1,543 per adult. Annual costs of severe asthma plus SAR increased to 7,928 per child/adolescent and to 9,287 per adult. For TPPs, the main cost drivers were medication, hospitalisation, and rehabilitation. The most significant costs for patients were household modifications. For children/adolescents, 60–78% of the expenditures were direct costs, while in adults, 58% of expenditures were indirect costs. It was also observed that patients with moderate and severe asthma used inhaled corticosteroids less frequently than recommended by treatment guidelines.
In summary, the total cost for patients increases with the severity of atopic asthma and/or seasonal allergic rhinitis and indirect costs represent a large proportion of the total cost.
There are no effective drugs for the treatment of cocaine dependence, and doctors do not agree on a best method of treatment. More than 400 substance abuse clinics in the USA and Europe offer a treatment for cocaine dependence called auricular acupuncture. In this treatment, needles are usually inserted into five specific points in the ear, but some clinics use only four or three of the points. In this Cochrane review the authors set out to discover whether auricular acupuncture is effective in treating cocaine dependence and whether the number of points used makes a difference. The authors searched the medical literature for studies called randomized controlled trials, in which one group of patients receives a treatment (such as acupuncture) and is compared with a similar group who receives a different treatment or no treatment (the control group). The authors found seven studies with a total of 1433 people. Most of the studies compared acupuncture with 'sham' acupuncture in which needles were inserted into random places in the ear but not into the specific points required for treatment. The studies used a variety of acupuncture techniques, using three, four, or five of the treatment points. The studies had a number of problems with the way their results were reported. The authors conclude that there is no evidence that any form of auricular acupuncture is effective for treating cocaine dependence. They recommend that better research be done, since it was difficult for them to draw conclusions from the few available studies.
To investigate the effectiveness and safety of acupuncture in persistent allergic rhinitis (PAR) DESIGN: Randomised, single-blind, sham-controlled trial conducted from May 2004 to February 2005.
80 patients with PAR (age, 16-70 years) were randomly assigned to receive real or sham acupuncture. After a 1-week baseline period, participants were treated twice weekly for 8 weeks and followed up for another 12 weeks.
Nasal obstruction, sneezing, rhinorrhoea and nasal itch were each self-assessed daily on a 5-point scale, and scores were aggregated weekly. The sum of the symptom scores (total nasal symptom score, TNSS) was also determined. A secondary outcome was use of PAR relief medication.
After 8 weeks' treatment, the weekly mean difference in TNSS from baseline was greater with real (-17.2; 95% CI, -24.6 to -9.8) than with sham acupuncture (-4.2; 95% CI, -11.0 to 2.7) (P = 0.01). The decrease in individual symptom score was also greater with real acupuncture for rhinorrhoea (P < 0.01) but not the other symptoms. At the end of follow-up, the greater difference in TNSS from baseline in the real acupuncture group was still apparent: real, -21.0 (95% CI, -29.1 to -12.9) versus sham, - 2.3 (95% CI, -10.2 to 5.6) (P = 0.001). Moreover, the differences from baseline in all four individual symptom scores were greater for the real than for the sham group (P < 0.05). Real and sham acupuncture were both well tolerated.
Our findings suggest that acupuncture is effective in the symptomatic treatment of PAR.
Australian Government Therapeutic Goods Administration CTN 034/2004.
Allergies cause a considerable burden to both sufferers and the National Health Service. There is growing interest in acupuncture as a treatment for a range of conditions. Since acupuncture may modulate the immune system it could be a useful treatment for allergic rhinitis (AR) sufferers. We therefore assessed the evidence for the clinical effectiveness of acupuncture in patients with AR by performing a systematic review of the literature.
Searches (to 2007) were conducted in all major databases for randomised controlled trials (RCTs) evaluating the clinical effectiveness of acupuncture in the treatment of AR. No limits were placed on language. Studies were included if they compared acupuncture to a sham or inactive acupuncture treatment (placebo) with or without standard care. Meta-analysis was performed where feasible.
Seven relevant RCTs were included after screening and application of inclusion and exclusion criteria. The trials were generally of poor quality as assessed by a modified Jadad scale, with the exception of two studies which scored highly. A wide variety of outcomes was measured but most assessed symptom severity on a visual analogue scale. A meta-analysis failed to show any summary benefits of acupuncture treatment for symptom severity scores or serum IgE measures which could not have been accounted for by chance alone. Acupuncture was not associated with any additional adverse events in the trials.
There is currently insufficient evidence to support or refute the use of acupuncture in patients with AR. A large well conducted RCT, which overcomes identified methodological problems in the existing RCTs, would be required to resolve this question.
This is the protocol for a review and there is no abstract. The objectives are as follows:
(1) To determine whether auricular acupuncture is effective in treating cocaine dependence;
(2) To determine whether variations in treatment such as modification of the NADA protocol, or additional treatments used along with acupuncture, influence its effectiveness.
This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the therapeutic effectiveness of Chinese herbal medicine for allergic rhinitis, and consider adverse events. © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.
In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.
This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.
The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.
Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.
The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.
Allergic rhinitis is a symptomatic disorder of the nose induced after allergen exposure by an IgE-mediated inflammation of the membranes lining the nose. It is a global health problem that causes major illness and disability worldwide. Over 600 million patients from all countries, all ethnic groups and of all ages suffer from allergic rhinitis. It affects social life, sleep, school and work and its economic impact is substantial. Risk factors for allergic rhinitis are well identified. Indoor and outdoor allergens as well as occupational agents cause rhinitis and other allergic diseases. The role of indoor and outdoor pollution is probably very important, but has yet to be fully understood both for the occurrence of the disease and its manifestations.
In 1999, during the Allergic Rhinitis and its Impact on Asthma (ARIA) WHO workshop, the expert panel proposed a new classification for allergic rhinitis which was subdivided into 'intermittent' or 'persistent' disease.
This classification is now validated. The diagnosis of allergic rhinitis is often quite easy, but in some cases it may cause problems and many patients are still under-diagnosed, often because they do not perceive the symptoms of rhinitis as a disease impairing their social life, school and work.
The management of allergic rhinitis is well established and the ARIA expert panel based its recommendations on evidence using an extensive review of the literature available up to December 1999. The statements of evidence for the development of these guidelines followed WHO rules and were based on those of Shekelle et al. A large number of papers have been published since 2000 and are extensively reviewed in the 2008 Update using the same evidence-based system. Recommendations for the management of allergic rhinitis are similar in both the ARIA workshop report and the 2008 Update. In the future, the GRADE approach will be used, but is not yet available.
Another important aspect of the ARIA guidelines was to consider co-morbidities. Both allergic rhinitis and asthma are systemic inflammatory conditions and often co-exist in the same patients. In the 2008 Update, these links have been confirmed.
The ARIA document is not intended to be a standard-of-care document for individual countries. It is provided as a basis for physicians, health care professionals and organizations involved in the treatment of allergic rhinitis and asthma in various countries to facilitate the development of relevant local standard-of-care documents for patients.
From the concept of a diagonally dominant matrix, two sufficient conditions of nonsingular H-matrices were obtained in this paper. An example was
given to show that these results improve the known results.
Rev. ed., 11th print. Přeloženo z čínštiny?
To assess quality of life and cost-effectiveness of additional acupuncture treatment for allergic rhinitis, patients were randomly allocated to 2 groups; both received usual care, but one group received an additional 10 acupuncture sessions. Quality of life (according to the SF-36 Health Survey), and direct and indirect costs, were assessed at baseline and after 3 months, and the incremental cost-effectiveness ratio of acupuncture treatment was calculated. This German study (December 2000-June 2004) involved 981 patients (64% women, mean age 40.9 years (standard deviation, 11.2); 36% men, mean age 43.2 years (standard deviation, 13.0)). At 3 months, quality of life was higher in the acupuncture group than in the control group (mean Physical Component Score 51.99 (standard error (SE), 0.33) vs. 48.25 (SE, 0.33), P < 0.001; mean Mental Component Score 48.55 (SE, 0.42) vs. 45.35 (SE, 0.42), respectively, P < 0.001). Overall costs in the acupuncture group were significantly higher than those in the control group (Euro (euro; 1 euro = US $1.27) 763, 95% confidence interval: 683, 844 vs. 332 euro, 95% confidence interval: 252, 412; mean difference 432 euro, 95% confidence interval: 318, 545). The incremental cost-effectiveness ratio was 17,377 euro per quality-adjusted life year (women, 10,155 euro; men, 44,871 euro) and was robust in sensitivity analyses. Acupuncture, supplementary to routine care, was beneficial and, according to international benchmarks, cost-effective. However, because of the study design, it remains unclear whether the effects are acupuncture specific.
Acupuncture is widely used in patients with allergic rhinitis, but the available evidence of its effectiveness is insufficient.
To evaluate the effectiveness of acupuncture in addition to routine care in patients with allergic rhinitis compared with treatment with routine care alone.
In a randomized controlled trial, patients with allergic rhinitis were randomly allocated to receive up to 15 acupuncture sessions during a period of 3 months or to a control group receiving no acupuncture. Patients who did not consent to random assignment received acupuncture treatment. All patients were allowed to receive usual medical care. The Rhinitis Quality of Life Questionnaire (RQLQ) and general health-related quality of life (36-Item Short-Form Health Survey) were evaluated at baseline and after 3 and 6 months.
Of 5,237 patients (mean [SD] age, 40 [12] years; 62% women), 487 were randomly assigned to acupuncture and 494 to control, and 4,256 were included in the nonrandomized acupuncture group. At 3 months, the RQLQ improved by a mean (SE) of 1.48 (0.06) in the acupuncture group and by 0.50 (0.06) in the control group (3-month scores, 1.44 [0.06] and 2.42 [0.06], respectively; difference in improvement, 0.98 [0.08]; P < .001). Similarly, quality-of-life improvements were more pronounced in the acupuncture vs the control group (P < .001). Six-month improvements in both acupuncture groups were lower than they had been at 3 months.
The results of this trial suggest that treating patients with allergic rhinitis in routine care with additional acupuncture leads to clinically relevant and persistent benefits. In addition, it seems that physician characteristics play a minor role in the effectiveness of acupuncture treatment, although this idea needs further investigation.
A nationwide survey on the prevalence and risk factors for perennial allergic rhinitis in Korea was conducted by means of physical examination by otolaryngologists from July to October 1991. The total number of subjects examined was 9069 and they were drawn from 2899 households in 60 different districts throughout the country. The overall prevalence of perennial allergic rhinitis was 1.14%. For the evaluation of risk factors for perennial allergic rhinitis, a case-control analysis was carried out. The prevalence was influenced by age and urban or rural province. Risk factors such as current urban residence, urban birth place, overcrowding, higher educational attainment, nasal septal deformity and chronic sinusitis with nasal polyposis, indicated an increased risk of perennial allergic rhinitis. Other factors such as smoking and personal factors showed little influence on prevalence.
Herbal therapies have been widely used in allergic rhinitis (AR), but none have been shown to be effective in controlled scientific clinical trials.
The aim of this study was to test the effects of the Chinese herbal formulation Biminne in patients with moderate to severe perennial AR.
In a randomized, double-blind, placebo-controlled clinical trial, 58 patients were randomized to receive either Biminne capsules (n = 26) or placebo (n = 32) in doses of five capsules twice a day for 12 weeks. Main outcomes were measured by changes in symptom diaries, quality of life scores, patients' evaluations of improvement on visual analog scores, and physicians' overall evaluation. Total serum immunoglobulin E was measured in all patients without knowledge of which group they were in. After 1 year we performed a randomized, double-blind, dose-response study in 22 patients who had previously received placebo.
The trial outcomes evaluated by four instruments showed a statistically significant improvement in some of the symptoms of AR, whereas others exhibited a positive trend that did not reach statistical significance. Followup 1 year after completion of the trial suggested that benefit of the treatment persisted. A pilot dose-response study showed both half and full strengths were effective. Total serum immunoglobulin E was reduced after the herbal treatment.
Our results suggest the Biminne formulation is effective in treatment of perennial AR. Its mode of action is unknown.
There is evidence that the use of alternative medicine (AM) for allergies has increased. However, little is known from population-based studies about what determines its use. The objective of this study was to evaluate the patterns of use of AM for allergies.
A population-based nested case-control study was conducted in 2000-01 using computer-assisted telephone interviews. Three hundred and fifty-one adults participated (median age 46 years) with allergies including hay fever, asthma, atopic eczema, and food hypersensitivity. Information was obtained on demographics, prevalence, motivation, information, type of AM, provider, costs, willingness to pay, and subjective assessment of AM.
26.5% of participants used AM because of their allergies. Compared to nonusers, this group of users was significantly younger (median age 43 vs 47; p=0.004) and better educated (school education > 8 year vs<or= 8 year; odds ratio (OR) 2.17, 1.28-3.67) and was mostly motivated by the assumption of few side-effects (78.3%), by a wish to try everything (71.7%), and by unsatisfying results from conventional therapy (66.3%). Users also had more experience with conventional therapy than nonusers (94.6% vs 63.6%; OR 10.10, 4.00-25.72). Four procedures accounted for almost the entire usage: homeopathy (35.3%), autologous blood injection (28.1%), acupuncture (16.6%), and bioresonance (10.0%). The AM were mostly promoted (40.2%) and provided (60.9%) by medical doctors, and produced median costs for single and entire treatment of 4 (15-205) and 205 (15-1278) euros. Reimbursement from insurance companies was received by 52.3%, in full (37.8%) or partial (14.5%). Most subjects (55.4%) admitted that they would pay more (median 153 euros) for the achieved result. Users scored the efficacy of conventional therapy significantly lower (p<0.001) than nonusers, and assessed the results of AM as very good (28.6%) or rather good (53.8%).
AM is used widely for allergies by the general population and is associated with considerable costs. This has implications for the health care system and health policy.
To examine the long-term effect of auricular therapy using magnetic pearls administered for the elderly suffering from insomnia.
A follow-up study after a randomized controlled trial.
Four hostels for the elderly in Hong Kong.
This paper focuses on reporting the long-term effect of auricular therapy using magnetic pearls in the experimental group of a randomized controlled study. Fifteen volunteer participants were followed up at 1-, 3-, and 6-month intervals after a 3-week treatment course.
Objective sleep parameters using actigraphic monitoring were collected at different intervals of time after the therapy.
Results of RANOVA demonstrate that there was a significant difference of nocturnal sleep time (F(2.30,29.90)=3.63, P<0.05) and marginally differences of sleep efficiency (F(4,52)=2.52, P=0.05) at baseline, immediately after the therapy, and at the three time intervals at 1, 3 and 6 months. The results illustrate that the mean nocturnal sleep time (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) also remained constant over the 6-month follow up period. The results of least square polynomial regression analysis also illustrate that the mean NST (F=4.95, P=0.30, R(2)=0.91) and the mean sleep efficiency (F=13.50, P=0.19, R(2)=0.96) remained constant over the 6-month follow up period.
The results of this follow up study indicate that auricular therapy using magnetic pearls could have a long-term effect, at least within the observed period of time, on improving the quality as well as the quantity of sleep among the elderly.
Chinese herbal medicine (CHM) is widely used to treat seasonal allergic rhinitis (SAR), however, evidence of efficacy is lacking.
To evaluate the efficacy of a Chinese herbal formulation for the treatment of SAR.
Randomized, double blind, placebo controlled trial.
RMIT Chinese Medicine Clinic.
55 patients with seasonal allergic rhinitis (active 28, placebo 27).
CHM extract capsule (containing 18 herbs) or placebo, given daily for 8 weeks.
The primary measure of efficacy were changes in severity of nasal and non-nasal symptoms using a Five Point Scale (FPS) measured by both patients and the practitioner. The secondary measure was the change in score for the domains measured in the Rhinoconjunctivitis and Rhinitis Quality of Life Questionnaire (RQLQ) assessed by patients.
Forty-nine patients completed the study (active 24, placebo 25). After eight weeks, the severity of nasal symptoms and non-nasal symptoms were significantly less in the active treatment group than in the control group, both for measurements made by patients and those by the practitioner. Comparison of active and placebo treatment groups RQLQ scores also indicated significant beneficial effects of treatment (end point Section 1: P < 0.05; Section 2: P < 0.01). Intention-to-treat analyses of categorical items showed moderate to marked improvement rates were 60.7% and 29.6% for active and placebo respectively. Eleven patients reported mild adverse events including 1 withdrawn from the trial.
This CHM formulation appears to offer symptomatic relief and improvement of quality of life for some patients with seasonal allergic rhinitis.
This study tested the viability of auricular acupuncture in prisons for alleviating inmates' symptoms of psychological and physical discomfort and reducing their drug use. The experimental NADA-Acudetox protocol was compared with a non-specific helix control protocol in a randomized trial. Over a period of 18 months, a 4-week, 14-session auricular acupuncture treatment program was offered in two prisons to 163 men and women with self-reported drug use. Among treatment completers, no differences by method were found in self-reported symptoms of discomfort. Drug use occurred in the NADA group but not in the helix group. In contrast, confidence in the NADA treatment increased over time while it decreased for the helix treatment. No significant negative side effects were observed for either method. Participants in both groups reported reduced symptoms of discomfort and improved nighttime sleep. Future research should compare auricular acupuncture to a non-invasive control in order to attempt to disentangle active effects from placebo.
To measure the prevalence of allergic rhinitis among European adults and the proportion of undiagnosed subjects, a two-step, cross-sectional, population-based survey in Belgium, France, Germany, Italy, Spain, and the UK was undertaken.
Step one of the study involved screening for allergic rhinitis by telephone interview, based on history of symptoms and/or self-awareness of the condition. Step two undertook confirmation of allergic rhinitis in a subset of the subjects screened positive; this was performed by a clinical diagnosis conducted in three to five clinical centres per country, including specific immunoglobulin E tests and a disease-specific questionnaire.
A total of 9,646 telephone interviews were conducted between February and April 2001. Self-awareness of allergic rhinitis was reported by 19% of the subjects. Physician-based diagnosis of allergic rhinitis was reported by 13% of the subjects. In step two, 725 clinical assessments were conducted between May and August 2001. A total of 411 of patients, who underwent step two, had investigator-confirmed allergic rhinitis. Among patients with investigator-confirmed allergic rhinitis, 45% had not reported a previous diagnosis by a physician. Prevalence of subjects with clinically confirmable allergic rhinitis estimated by combining step one and step two data ranged from 17% in Italy to 29% in Belgium with an overall value of 23%.
This large-scale study confirms that allergic rhinitis has a high prevalence in western Europe and is frequently undiagnosed.
To compare active acupuncture with sham acupuncture for the treatment of persistent allergic rhinitis among children.
Subjects with persistent allergic rhinitis were recruited from the pediatric outpatient clinic. They were randomized to receive either active acupuncture or sham acupuncture. Main outcome measures included daily rhinitis scores, symptom-free days, visual analog scale scores for immediate effects of acupuncture, daily relief medication scores, blood eosinophil counts, serum IgE levels, nasal eosinophil counts, patients' and parents' preferences for treatment modalities, and adverse effects.
Eighty-five patients were recruited from the pediatric outpatient clinic at Kwong Wah Hospital, in Hong Kong. Thirteen patients withdrew before randomization; 35 patients (mean age: 11.7 +/- 3.2 years) were randomized to receive active acupuncture for 8 weeks, and 37 patients (mean age: 11 +/- 3.8 years) were randomized to receive sham acupuncture for 8 weeks. Acupuncture was performed twice per week for both groups. Both the assessing pediatricians and the patients were blinded. There were significantly lower daily rhinitis scores and more symptom-free days for the group receiving active acupuncture, during both the treatment and follow-up periods. The visual analog scale scores for immediate improvement after acupuncture were also significantly better for the active acupuncture group. There was no significant difference in the following outcome measures between the active and sham acupuncture groups: daily relief medication scores, blood eosinophil counts, serum IgE levels, and nasal eosinophil counts, except for the IgE levels before and 2 months after acupuncture in the sham acupuncture group. No severe adverse effects were encountered. Numbness, headache, and dizziness were found in both the active and sham acupuncture groups, with no difference in incidence, and the effects were self-limiting.
This study showed that active acupuncture was more effective than sham acupuncture in decreasing the symptom scores for persistent allergic rhinitis and increasing the symptom-free days. No serious adverse effect was identified. A large-scale study is required to confirm the safety of acupuncture for children.
The subjective recording in diary cards of symptoms of itch, sneeze, nose running, and blockage, with the use of a rating scale to indicate the level of severity, is usual for clinical trials in allergic rhinitis. The primary outcome measure is usually a composite score that enables a single total symptoms score endpoint. It is appreciated, however, that rhinitis has a greater effect on the individual than is reflected purely by the recording of anterior nasal symptoms. Nasal obstruction is troublesome and may lead to sleep disturbance in addition to impaired daytime concentration and daytime sleepiness. These impairments affect school and work performance. Individuals with rhinitis find it socially embarrassing to be seen sneezing, sniffing, or blowing their nose. To capture these and other aspects of the disease-specific health-related quality of life, questionnaires such as the Rhinoconjunctivitis Quality of Life Questionnaire have been developed and validated for clinical trial use. The adoption of health-related quality of life questionnaires into clinical trials broadens the information obtained regarding the effect of the therapeutic intervention and helps focus on issues relevant to the individual patient. It must be appreciated that it is not only the disease that may adversely affect health-related quality of life; administered therapy, although intended to be beneficial, may also cause health impairment. Adverse-event monitoring is thus essential in clinical trials. The first-generation H 1 -histamines, because of their effect on central H 1 -receptors, are classically associated with central nervous system (CNS) effects such as sedation. Although this is not always perceived by the patient, it is clearly evident with objective performance testing, and positron emission tomography scanning has directly demonstrated the central H 1 -receptor occupancy. The second-generation H 1 -antihistamines have reduced central H 1 -receptor occupancy and considerably reduced or absent CNS sedative effects. Therefore, the CNS effects are entirely avoidable, and the first-generation H 1 -antihistamines should no longer be used in the management of allergic rhinitis. The considerably rarer but potentially very serious cardiac arrhythmogenic effects of H 1 -antihistamines are appreciated to be molecule-specific rather than class-specific. The in vitro screening of new compounds to eliminate the further development of those with cardiotoxicity ideally will lead to this adverse effect being historic. The incorporation of electrocardiogram recording in clinical trials provides direct information relating to prolongation of QT interval corrected for heart rate. Although administered at low doses, intranasal steroids still have the potential for systemic absorption and adverse consequences. However, it is appreciated that meaningful differences exist in the bioavailability of different steroid molecules, and although a small but statistically significant effect on growth in children has been identified with the long-term use of intranasal beclomethasone when administered twice daily for 1 year, this is not evident with all intranasal steroids. In addition, twice-daily intranasal steroid administration may have more effect--from the endocrinologic perspective--than once-daily administration in the morning, which coincides better with the natural diurnal variation in cortisol. Thus, once-daily intranasal steroid administration is preferable, and when used in studies in children, measurement of height change during the study period is an important outcome variable together with other indices of systemic steroid bioavailability (eg, tests of hypothalamic-pituitary-adrenal axis function). These considerations have even greater relevance if children are concurrently also receiving inhaled steroids for asthma, because the total steroid load will be greater.
Auricular acupressure is known to decrease the level of anxiety in patients during ambulance transport. The purpose of this randomized, double-blind, sham control study was to determine whether auricular acupressure can decrease not only the level of anxiety but also the level of pain in a group of elder patients with acute hip fracture.
With the assistance of the Vienna Red Cross, 38 patients with acute hip fracture were enrolled into this study. Patients were randomized into two study groups: the true intervention group and the sham control group. Subjects in the true intervention group (n = 18) received bilateral auricular acupressure at three auricular acupressure points for hip pain. Patients in the sham group (n = 20) received bilateral auricular acupressure at sham points. Baseline demographic information, anxiety level, pain level, blood pressure, and heart rate were obtained before the administration of the appropriate acupressure intervention. The level of anxiety, level of pain, hemodynamic profiles, and level of satisfaction were reassessed once the patients arrived at the hospital.
Patients in the true intervention groups had less pain (F = 28, p = 0.0001) and anxiety (F = 4.3, p = 0.018) and lower heart rate (F = 18, p = 0.0001) on arrival at the hospital than did patients in the sham control group. As a result, the patients in the true intervention group reported higher satisfaction in the care they received during the ride to the hospital.
The authors encourage physicians, health care providers, and emergency rescuers to learn this easy, noninvasive, and inexpensive technique for its effects in decreasing anxiety and pain during emergency transportation.
Complementary-alternative medicines are extensively used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking. To provide evidence-based recommendations, the literature was searched by using MedLine and the Cochrane Library to March 2005 (Key words: Asthma [OR] Rhinitis, [AND] Complementary [OR] Alternative Medicine, [OR] Herbal, [OR] Acupuncture, [OR] Homeopathy, [OR] Alternative Treatment). Randomized trials, preferably double-blind and published in English, were selected. The articles were evaluated by a panel of experts. Quality of reporting was assessed by using the scale validated by Jadad. The methodology of clinical trials with complementary-alternative medicine was frequently inadequate. Meta-analyses provided no clear evidence for the efficacy of acupuncture in rhinitis and asthma. Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed. A limited number of studies of herbal remedies showed some efficacy in rhinitis and asthma, but the studies were too few to make recommendations. There are also unresolved safety concerns. Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.
To compare therapeutic effects of acupuncture and auricular point pressing therapy on allergic rhinitis.
One hundred and fifty cases were randomly divided into an acupuncture group, an auricular point pressing group and a medication control group, 50 cases in each group. The acupuncture group were treated with acupuncture for 6 consecutive days, once each day, with an interval of one day; and the auricular point pressing group were alternatively treated twice each week; the medication group were treated with oral administration of western medicine saitezan, once daily, 10 mg once. They were treated for 4 weeks, and the short-term and long-term therapeutic effects, and effects on serum immunological indexes were compared among the three groups.
The acupuncture group and the auricular point pressing group in the short-term therapeutic effect and improvement of cumulative scores of symptoms and signs, and the long-term total therapeutic effect and the improvement of cumulative scores of symptoms and signs were better than the medication group (P<0.01, P<0.05), with no significant differences between the acupuncture group and the auricular point pressing group. Serum IgE, IL-4 contents decreased and IFN-gamma level did not significantly change in the three groups.
Acupuncture and auricular pressing therapy in improvement of symptoms and signs are better than the medication, and the therapeutic effect is carried out by inhibiting the differentiation from Th cells to Th2 cells, adjusting the imbalance of Th1/Th2 cells and decrease the synthesis of IgE to inhibit allergic rhinitis.
Auricular acupuncture can be an effective treatment for acute anxiety, but there is a lack of direct comparisons of acupuncture to proven standard drug treatments. In this study we compared the efficacy of auricular acupuncture with intranasal midazolam, placebo acupuncture, and no treatment for reducing dental anxiety. Patients having dental extractions (n = 67) were randomized to (i) auricular acupuncture, (ii) placebo acupuncture, and (iii) intranasal midazolam and compared with a no treatment group. Anxiety was assessed before the interventions, at 30 min, and after the dental extraction. Physiological variables were assessed continuously. With the no treatment group as control, the auricular acupuncture group, and the midazolam group were significantly less anxious at 30 min as compared with patients in the placebo acupuncture group (Spielberger Stait-Trait Anxiety Inventory X1, P = 0.012 and <0.001, respectively). In addition, patient compliance assessed by the dentist was significantly improved if auricular acupuncture or application of intranasal midazolam had been performed (P = 0.032 and 0.049, respectively). In conclusion, both, auricular acupuncture and intranasal midazolam were similarly effective for the treatment of dental anxiety.
Free radicals and lipid peroxides, both of which are easily formed in the diabetic state, play an important role in the development of diabetic complications. Antioxidative therapy may help prevent diabetic complications caused by lipoperoxidation and free-radical formation in diabetes mellitus (DM). A number of findings suggest that oxidative stress exists in persons with high-risk DM. Auricular pellet acupressure has reportedly been an effective treatment method for a variety of medical conditions, including anxiety, juvenile myopia, essential hypertension, and senile vascular dementia. However, its effects on antioxidative enzymes have not been elucidated. We therefore evaluated the impact of auricular pellet acupressure on antioxidative status in persons with high-risk DM.
Our study involved 69 persons with high-risk DM, who were allocated either to undergo acupressure as active treatment for the experimental group or to a control group.
The experimental group in the study received auricular pellet acupressure three times daily for 5 consecutive days. After a 2-day rest period, the procedure was performed on the contralateral ear. Acupressure was performed twice on each ear, with each application followed by its application to the contralateral ear, over a total treatment period of 20 days. The control groups did not undergo auricular pellet acupressure.
At the end of the 20-day period of treatment of the experimental group, blood was collected from all of the study participants for assay of serum superoxide dismutase (SOD) and catalase concentrations, as was also done for the control group.
Serum concentrations of SOD (p < 0.05) and catalase (p < 0.0001) were significantly higher in the experimental group than in the control group.
Our findings suggest that auricular pellet acupressure can increase the concentration of antioxidative enzymes in persons with high-risk DM.
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