OBJECTIVE: To use evidence-based medicine to explore the efficacy of acupoint application (AA) for allergic rhinitis (AR) at different time points and its safety.

METHODS: We searched 7 databases (PubMed, Cochrane, Embase, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and China Biology Medicine disc) as well as the international clinical trial registration platform from January 2010 to March 2020 for randomized controlled trials (RCTs) comparing the efficacy of AA versus placebo, Western Medicine or other alternative therapies on AR. Risk of bias was assessed according to the Cochrane handbook, and statistical analysis was performed using RevMan 5.3. Outcomes included the total effective rate, recurrence rate, total nasal symptom score (TNSS), visual analogue scale (VAS), quality of life measured by the Rhinitis Quality of Life Questionnaire (RQLQ) or Short Form-36 (SF-36), adverse events, and biomarkers including immunoglobulin E (IgE), peripheral blood eosinophil count (EOS), interleukin-4 (IL-4), and interferon gamma (INF-γ).

RESULTS: Twenty-eight RCTs involving 3282 participants were included. The short-term and long-term efficacy of AA was significantly better than placebo, including better total effective rate [RR: 3.05, 95%CI (1.84, 5.07), after treatment; RR: 9.29, 95%CI (2.57, 33.66), at 6 months], lower recurrence rate [RR: 0.55, 95%CI (0.45, 0.66), at 6 months; RR: 0.65, 95%CI (0.57, 0.74), at 1 year], lower TNSS [MD: –3.09, 95%CI (–3.58, –2.61), after treatment], and lower RQLQ [MD: –14.79, 95%CI (–21.49, –8.10), after treatment; MD: –11.92, 95%CI (–17.40, –6.45), at 4-6 months]. Compared with Western Medicine, AA had better long-term total effective rate [RR: 1.33, 95%CI (1.05, 1.69), at 3 months; RR: 1.49, 95%CI 1.22 to 1.81, at 1 year) and lower recurrence rate [RR: 0.48, 95%CI (0.39, 0.58), at 6 months; RR: 0.45, 95%CI (0.33, 0.60), at 1 year]. AA had better long-term total effective rate versus acupuncture [RR: 2.06, 95% CI (1.28, 3.31), at 1 year] or oral Chinese medicine [RR: 1.21, 95% CI (1.09, 1.34), ≥ 6 months]. Both AA and Western Medicine can reduce serum levels of IgE, EOS, and IL-4 after treatment. The main adverse event of AA was local skin reaction without systemic side effects.

CONCLUSIONS: The short-term (within one month) and long-term (at 3 months, 6 months and 1 year) efficacy of acupoint application on AR was better than that of placebo. The long-term efficacy of acupoint application was superior to that of Western Medicine (at 3 months, 6 months and 1 year), oral Chinese medicine (at more than 6 months) and acupuncture (at 1 year). AA can reduce serum IgE, EOS, and IL-4 level of AR patients in a short run. Acupoint application is safe, but severe skin reactions can reduce patient compliance.