Efficacy and safety of warm needle acupuncture for allergic rhinitis: A systematic review and meta-analysis with trial sequential analysis.

Backgrounds: Warm needle acupuncture is a distinct form of acupuncture therapy in which, after the needle is inserted into the acupoint, a lit moxa stick is placed on the needle's handle. Objective: This research aims to provide evidence for efficacy and safety of warm needle acupuncture for allergic rhinitis. Search strategies: Seven online databases were searched for study collection, which were published up to March 15th, 2022. Keywords of searching included "AR", "allergic rhinitis", "anaphylactic rhinitis", "warming needle", "warming needle acupuncture", "needle warming moxibustion", "warm needle", "warm needling method" and "warmed needle". The quality of the included trials was assessed using the Cochrane risk of bias tool. Interventions: Among the included trials, warm needle acupuncture-either alone or in combination with Western medicine or other acupoint-based therapies-served as the primary intervention for the experimental groups. In contrast, the control groups received treatments such as Western medicine alone, manual acupuncture alone, or a combination of electro and manual acupuncture. Systematic reviews and meta-analyses were conducted using RevMan 5.3, following the Cochrane systematic review methodology, while trial sequential analysis was performed with TSA 0.9. The quality of the findings was assessed using GRADEpro. Results: Finally, 23 studies involving 2230 participants were covered. Results of this study revealed that warm needle acupuncture only, or with western medicine, or with other acupoint-based interventions were significantly superior to western medicine alone, manual acupuncture alone, or electro plus manual acupuncture for allergic rhinitis. Adverse events associated with warm needle acupuncture included sensations of chest tightness, throat itching, and allergic reactions to moxa smoke; however, these occurrences were not more frequent than those observed with Western medicine. There is need for RCTs of high quality with placebo or waitlist controls of the intervention for allergic rhinitis. Conclusion: Warm needle acupuncture is with potential efficacy and is safe for patients with allergic rhinitis, but more trials are need for further confirmation of the evidence.