Rédacteurs : Johan Nguyen, Claude Pernice
Sommaire
Chronic Uricaria
Urticaire : évaluation de l'acupuncture
| Articles connexes: - conduites thérapeutiques - |
1. Systematic Reviews and Meta-Analysis
1.1. Generic Acupuncture
1.1.1. Zhao 2020 ☆
Zhao JQ, Ma TM. [A Meta-analysis of acupuncture therapy for chronic urticaria]. Acupuncture Research. 2020;45(1):66-73. [205819].
| Objective | To evaluate the efficacy of acupuncture therapy in the treatment of chronic urticaria. |
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| Methods | Randomized controlled trials of acupuncture treatment of chronic urticaria published from January of 2008 to October of 2018 were searched from databases of CNKI, VIP, Wanfang, CBM, PubMed, Embase and Cochrane Library by using key words “urticaria or urticarias” “acupuncture therapy” “acupuncture treatment” and “randomized controlled trial (RCT)”. The retrieved RCT papers were input into EndNote X8 document management software for screening the qualified ones, followed by evaluating the quality of the screened papers. The data extraction table was designed, and the information and data needed for the research were accurately extracted. Finally, Review Manager 5.3 software was used to analyze the included literature. |
| Results | A total of 1 095 articles were retrieved, and 16 RCTs were included finally. The Meta-analysis showed that the total therapeutic efficacy was OR＝3.85, 95% CI [2.61, 5.69], P<0.000 01. The diamonds for comparison between the acupuncture and control (medication) groups in the “Feng Tuan”(urticaria) number, itching, onset duration, swelling degree and scratch test scores were on the right side of the invalid line of forest maps. The recurrence rate (reported in 4 papers) was lower in the acupuncture group than in the control group (OR＝0.28, 95% CI being [0.14, 0.55], P＝0.000 3). |
| Conclusion | Acupuncture treatment is significantly better than antihistamine administration alone in the treatment of chronic urticaria, with lower recurrence rate. High-quality clinical studies with rigorous design and large sample sizes are needed for providing more reliable evidence. |
1.1.2. Zhang 2020 ☆
Zhang Binbin. [Meta-analysis of the clinical effect of acupuncture on chronic urticaria]. Hunan Journal of TCM. 2020. [212928].
| Objective | To systematically evaluate the clinical efficacy of acupuncture in the treatment of chronic urticaria in the past 10 years . |
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| Methods | A computer search for randomized controlled trials of acupuncture in the treatment of chronic urticaria in databases such as China Knowledge Network (CNKI), VIP Chinese Science and Technology Journals Database (VIP), Wanfang Data (WANFANG DATA), PubMed, etc. The search time limit is from March 2009 to March 2019. The quality of each included literature was evaluated by 2 researchers according to the modified Jadad standard, and the Rev Man 5. 3 software was used for Meta analysis. |
| Results | A total of 16 studies were included, with a total of 1325 patients. Meta-analysis results showed that the total effective rate of the treatment group was better than that of the control group: OR=3. 86, 95%CI[2. 71, 5. 49]> 1; recovery rate: OR=2. 23, 95%CI[ 1. 75, 2. 85]> 1; recurrence rate: OR=0. 34, 95%CI is [0. 16, 0. 72]<1. It shows that the total effective rate and recovery rate of the treatment group are higher than that of the control group, and the recurrence rate is lower than that of the control group. |
| Conclusion | Acupuncture is more effective in treating chronic urticaria than conventional western medicine, and can reduce the recurrence rate. |
1.1.3. Yao 2016 ☆
Yao Q, Li S, Liu X, Qin Z, Liu Z.. The Effectiveness and Safety of Acupuncture for Patients with Chronic Urticaria: a systematic review. Biomed Res Int. 2016. [171453]
| Objectives | Acupuncture might have effectiveness in relieving the symptoms of chronic urticaria. There are currently no systematic reviews of acupuncture for chronic urticaria published in English. Objective. We conducted a systematic review to assess the effectiveness and safety of acupuncture for chronic urticaria. |
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| Methods | A systematic review and meta-analysis of randomized, controlled trials were performed. The primary outcome was global symptom improvement. |
| Results | We included 6 studies with 406 participants. Three trials showed significant difference between acupuncture and drugs in global symptom improvement (relative risk 1.37; 95% CI 1.11-1.70; P = 0.003). As an adjuvant to medication, acupuncture was also beneficial for global symptom improvement (relative risk 1.77; 95% CI 1.41-2.22; P < 0.01). There were no severe adverse events related to acupuncture. Limitations. Some methodological limitations were observed. The overall risk of bias in the 6 included trials was high and all included RCTs were conducted in China and published in Chinese. Besides, the lack of proper control groups and the use of different rating methods and cut-offs in the included trials also made the evidence of this review limited. |
| Conclusions | Acupuncture might be effective and safe for chronic urticaria in relieving symptoms, based on a low level of evidence. To draw a reliable conclusion, more high quality trials are needed in the future. |
1.1.4. Yan 2015 ☆
Yan J, An y, Wang LS, Yi Li Y, Yang S. Acupoint stimulation for chronic urticaria: a systematic review of randomized controlled trials. European Journal of Integrative Medicine. 2015;7(6):586-92. [160486].
| Objective | Standard treatments are often unsatisfactory on chronic urticaria (CU). Acupoint stimulation, including acupuncture, electroacupuncture, acupoint catgut embedding, acupoint injection, has shown benefit about alleviating itching, reducing amount and range of the lesions. However, the methodological quality of these trials is unknown. Thus, the objective of this review is to evaluate the quality and effectiveness of acupoint stimulation for chronic urticaria. |
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| Methods | We searched PubMed, Embase, the Cochrane Central Register of Controlled Trials, CNKI, CBM, VIP, Wanfang databases from January 1966 to June 2015. Randomized controlled trials (RCTs) on acupoint stimulation for CU were included. The Cochrane risk of bias tool was used to evaluate methodological quality. |
| Results | Eight RCTs met the inclusion criteria, which were all low quality. Acupuncture plus other treatment was significantly superior to western medicine alone and autologous blood injection plus herbal medicine was better than herbal medicine alone in increasing the number of cured patients. |
| Conclusions | Acupoint stimulation may provide benefit in CU; however, more large scale, high quality studies are needed for assessing the effects before it is recommended. |
1.1.5. Li 2009
Li Bo, Shi Lei, Du Yuanhao. [Systematic review on randomized controlled trials of acupuncture therapy for chronic urticaria]. Journal of Traditional Chinese Medicine. 2009;5:432-436. [187018].
| Objective | To assess the effect of acupuncture on chronic urticaria (CU) and to analyze the present situation of clinical researches. |
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| Methods | The data of randomized controlled trials of acupuncture for treatment of CU were collected by retrieval tools PubMed, EMBASE, OVID, Cochrane library, CBM database, and CNKI database, and the quality was assessed with Cochrane Reviewer’s Handbook. |
| Results | Totally 12 literatures entered the research, altogether 983 cases. Meta-analysis showed that the difference between the groups of acupuncture and western medicine treatment was significant; the difference between the groups of acupuncture plus western medicine and western medicine treatment was significant; and the difference between the groups of acupuncture plus antihistamine drugs and only antihistamine drugs treatment was significant in recurrence rate. |
| Conclusion | Acupuncture is effective and safe for CU. The effect of acupuncture plus drugs is better than that of treatment only with drug. The recurrence rate is lower when antihistamine drugs are used in combination with acupuncture. But because the entered literatures are not enough in quantity and some of them are low in quality, therefore the high quality evidence is needed for the further definite conclusion. |
1.2. Special Acupuncture Techniques
1.2.1. Acupoint catgut embedding
1.2.1.1. Xing 2022 ☆
Weiying Xing, Xuan Wang, Ying Zhang, Wentao Zhu. Effectiveness and safety of acupoint catgut embedding combined with Chinese herbal medicine in chronic urticaria: A systematic review of randomized controlled trials. Journal of Traditional Chinese Medical Sciences. 2022;9(4):365-373. https://doi.org/10.1016/j.jtcms.2022.09.008.
| Objective | To evaluate the effectiveness and safety of acupoint catgut embedding (ACE) in combination with Chinese herbal medicine (CHM) in treating chronic urticaria (CU). |
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| Methods | We thoroughly searched Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wangfang database, Chinese Scientific Journal Database (VIP), and Chinese biomedical literature database (SinoMed) for relevant studies from inception until May 2022. Randomized controlled trials (RCTs) on ACE combined with CHM for CU were included. Literature search, data extraction, and risk of bias assessment were independently conducted by two authors. |
| Results | A total of 15 RCTs with 1065 participants were included in this review. Five trials reported that the combined therapy showed a higher total effective rate, and four trials reported that the combined therapy was associated with a lower level of serum immunoglobulin E. Furthermore, two, four, and four trials reported that the combined therapy was more effective in reducing itching degree, size, and number of wheals, respectively. The combined therapy was reported to be associated with a lower recurrence rate in three trials, and with a fewer adverse reaction rate in two trials. |
| Conclusions | ACE in combination with CHM appears to be a safe and effective therapy for patients with CU. Given the relatively low quality of the included trials, these findings should be interpreted cautiously. Further high-quality RCTs are needed to confirm our findings. |
1.2.2. Cupping
1.2.2.1. Chae 2025 (Cupping on CV8 Shenque)
Chae SY, Sung WS, Kim EJ, Park SS. The Effectiveness and Safety of Cupping Therapy on CV8 Shenque for Urticaria: A Systematic Review and Meta Analysis. Altern Ther Health Med. 2025 Mar;31(2):49-55.
| Backgound | Cupping therapy (CT) on acupoint CV8 Shenque is a potential treatment of urticaria. This review will analyze the efficacy and safety of CT on CV8 Shenque. |
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| Methods | Randomized controlled trials (RCTs) comparing CT on CV8 Shenque with other treatments were retrieved from 14 worldwide databases from their inception to June 2024. Primary outcomes were symptom scores (SS), quality of life (QoL), and effective rate (ER). Using Review Manager, results were presented as risk ratio (RR) or mean difference (MD), with a 95% confidence interval (CI). The risk of bias was assessed using the Cochrane “risk of bias” tool, and the quality of evidence was evaluated with the Grading of Recommendations Assessment, Development, and Evaluation (GRADE). |
| Results | A total of six RCTs with 409 patients were included. Compared with other treatments, CT on CV8 Shenque significantly improved ER (RR = 1.20, 95% CI [1.07, 1.35], P = .002, 6 RCTs, n = 409), SS (including wheal scores (MD = -0.64, 95% CI [-0.91, -0.37], 2 RCTs, n = 123), symptom duration scores (MD = -0.37, 95% CI [-0.62, -0.12], 2 RCTs, n = 123), and QoL (MD = -2.08, 95% CI [-3.28, -0.88], 1 RCT, n = 66). |
| Conclusion | CT on CV8 Shenque can be a potential therapy for urticaria. Since the overall quality and quantity of the included RCTs were not satisfactory, high-quality research is necessary to further verify the results in the future. |
1.2.2.2. Xiao 2020
Xiao XJ, Zhang LX, Shi YZ, Yao JP, … Li Y. Cupping therapy for patients with chronic urticaria: A systematic review and meta-analysis. Journal of Integrative Medicine. 2020;18(4):303-312. [211975]. doi
| Background | Chronic urticaria (CU) is a common skin disease, which has a negative effect on quality of life. Current treatments do not fully control the symptoms of urticaria for many CU patients, thus effective and safe treatments for CU are still needed. |
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| Objective | This review aims to evaluate the effectiveness and safety of cupping therapy in patients with CU. |
| Methods | The search strategy looked for the presence of related keywords, such as “chronic urticaria” and “cupping therapy,” in the title and abstract of research articles indexed in major databases. Randomized controlled trials (RCTs) were selected after querying nine electronic databases from their inception to May 2019 with the above search terms. Inclusion criteria RCTs were included if they recruited patients with CU who were intervened with dry or wet cupping. Publications could be written in Chinese or English. Data extraction and analysis Data were extracted, and the studies were assessed for the quality of their methodological design and risk of bias. Meta-analyses of the RCT data were conducted to assess the total effective rate of the treatment as the primary outcome. Skin disease quality of life index score, recurrence rate, and adverse events were assessed as secondary outcomes. Subgroup analyses were conducted based on different interventions. |
| Results | Thirteen comparisons from 12 RCTs involving 842 participants were included. There were no significant differences between wet cupping and medications in total effective rate (n = 372; risk ratio [RR] = 1.10, 95% confidence interval [CI] 0.97 to 1.25; P = 0.14) or recurrence rate (n = 240; RR = 0.56, 95% CI 0.23 to 1.36; P = 0.20). Cupping therapy, in combination with antihistamine treatment was more efficacious than antihistamines alone, with a greater total effective rate (n = 342; RR = 1.18, 95% CI 1.01 to 1.39; P = 0.03) and lower recurrence rate (n = 342; RR = 0.52, 95% CI 0.32 to 0.84; P = 0.007). Cupping therapy combined with acupuncture was more effective than acupuncture alone (n = 156; RR = 1.25, 95% CI 1.07 to 1.46; P = 0.006). No serious adverse events were reported. |
| Conclusion | Wet cupping may be as effective as treatment with antihistamines. When cupping therapy is used as an adjuvant therapy to antihistamines or acupuncture, it may enhance the efficacy. Results drawn from these studies should be interpreted with caution and applied with care to clinical practice, because of the poor quality among the studies that were reviewed. |
1.2.3. Pharmaco-acupuncture
1.2.3.1. Zhao 2019 (autohémothérapie au niveau des points)
Zhao Jian, Zhang Xin, Lin Pei-Ting, Hu Gui-Xing. [Meta-analysis on Autohemotherapy with Acupoint Injection for Chronic Urticaria]. Chinese Journal of Basic Medicine in TCM. 2019;25(12):1726. [207606].
| Objective | To assess the effectiveness and safety of autohemotherapy with acupoint injection in treating chronic urticarial (CU) . |
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| Methods | Papers of randomized controlled trials of autohemotherapy with acupoint injection for CU in databases of PubMed,CBM,VIP,CNKI,Wanfang from the database-established year to April of 2016 were searched by electronic and manual retrieval. Data extracting and methodological quality of the included literatures was evaluated and analysed by using Review Manager 5. 3 software. |
| Results | 12 trials involving 944 patients were included. The total effective rate in the autohemotherapy with acupoint injection were significantly better than western medicine and acupuncture therapy. The cure-remarkable-effectiveness rate in the autohemotherapy with acupoint injection were significantly better than western medicine and acupuncture therapy. The recurrence rate in the autohemotherapy with acupoint injection was significantly lower than control group. There was only one study reported the untoward effect, two studies no obvious adverse reactions. |
| Conclusion | The curative effect of autohemotherapy with acupoint injection is superior to acupuncture and western medicine. But due to Iimited sample size, low quality of included literature, however, more rigorously designed, multicenter, large sample and high-quality RCTs are needed to enforce. |
1.2.4. Auricular Acupuncture
1.2.4.1. Zhu 2018
Zhu L, Kim Y, Yang Z. The Application of Auriculotherapy to the Treatment of Chronic Spontaneous Urticarial: a Systematic Review and Meta-analysis. Journal of Acupuncture and Meridian Studies. 2018. 11(6):343-354. [168880].
| Backgound | Auriculotherapy has been extensively used for chronic spontaneous urticaria in China. However, the evidence of its effectiveness and safety for the treatment of chronic spontaneous urticaria is insufficient. |
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| Objective | Hence, we conducted this study to compare auriculotherapy or auriculotherapy joint treatment with western medicine for the cure of chronic spontaneous urticaria. |
| Results | This meta-analysis of seven RCTs showed that auriculotherapy or auriculotherapy joint treatment was significantly superior to western medicine in curing clinical signs and symptoms of chronic spontaneous urticaria (OR 2.61; 95% CI 1.54 to 4.43; p=0.0004), and also better in total effect rate (OR 3.81; 95% CI 2.07 to 7.01; p＜0.0001). But, auriculotherapy or auriculotherapy joint treatment was similar to western medicine in improving clinical signs and symptoms of chronic spontaneous urticaria (OR 0.74; 95% CI 0.35 to 1.56; p=0.42). Auriculotherapy or auriculotherapy joint treatment was safer than western medicine for curing chronic spontaneous urticaria (OR 0.26; 95% CI 0.09 to 0.80; p=0.02). |
| Conclusions | Auriculotherapy alone or auriculotherapy joint treatment appears to be more effective and safer than western medicine that contain antihistamines in the treatment of chronic spontaneous urticaria. However, these findings should be interpreted with caution due to the unclear risk bias of methodological quality and further studies with large-scale, better and more rigorously designed are necessary to prove these findings. |
1.2.5. Acupuncture combined with Chinese medicine
1.2.5.1. Lu 2022
Lu Z, Zhou Q, Chai S, Yang H, Wang J, Luo H, Cao Y, Tao M. Efficacy and safety of Chinese medicine combined with acupuncture in the treatment of chronic urticaria: A meta-analysis. Medicine (Baltimore). 2022 Sep 9;101(36):e30381. https://doi.org/10.1097/MD.0000000000030381
| Background | Increasing studies have shown that Chinese medicine combined with acupuncture has a significant effect on chronic urticaria, which can treat both symptoms and root causes. This meta-analysis aims to compare the efficacy and safety differences between acupuncture combined with conventional Western medicine, so as to provide guidance for the clinical treatment of chronic urticaria. |
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| Methods | We searched Pubmed, Embase, Cochrane Library, CNKI, Wanfang, CQVIP, and CBM from the establishment of the database to August 2021. We included randomized controlled trial study that the experimental group was acupuncture combined with traditional Chinese medicine, while the control group was treated with conventional Western medicine. We excluded repeated publication, researches without full text, incomplete information, or inability to conduct data extraction and animal experiments, reviews, and systematic reviews. STATA 15.1 was used to analyze the data. |
| Results | The pooled results show that total effective rate of acupuncture combined with traditional Chinese medicine group was significantly higher than that in the conventional Western medicine group (ratio rate [RR] = 1.29, 95% confidence interval [CI]: 1.2-1.38). Additionally, the pooled results show that Urticaria Activity Score (standardized mean difference = -1.51, 95% CI: -2.24 to -0.78) and pruritus score (standardized mean difference = -1.09, 95% CI: -1.71 to -0.47) of acupuncture combined with traditional Chinese medicine group was significantly lower than that in conventional Western medicine group, while there is no significant difference in wheal score between acupuncture combined with traditional Chinese medicine group and conventional Western medicine group. Importantly, the pooled results show that recurrence rate (RR = 0.35, 95% CI: 0.19-0.64) and the incidence of adverse events (RR = 0.27, 95% CI: 0.10-0.75) of acupuncture combined with traditional Chinese medicine group were all significantly lower than that in conventional Western medicine group. |
| Conclusion | Our research results found that traditional Chinese medicine combined with acupuncture has a more significant effect than conventional Western medicine and can significantly reduce the recurrence rate and the incidence of adverse reactions. The application of traditional Chinese medicine combined with acupuncture in the treatment of chronic urticaria should be further promoted. |
2. Overviews of Systematic Reviews
2.1. Shi 2019
Shi Y, Zhou S , Zheng Q , Huang Y , Hao P , Xu M , Zhang L , Xiao X , Zheng H , Li Y. Systematic reviews of pharmacological and nonpharmacological treatments for patients with chronic urticaria: An umbrella systematic review. Medicine (Baltimore). 2019;98(20). [198097].
| Background | A wide range of pharmacological and nonpharmacological interventions for chronic urticaria (CU) have been evaluated in systematic reviews (SRs). |
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| Objective | We conducted an umbrella review of SRs of the effectiveness and safety of pharmacological and nonpharmacological interventions for CU, which allow the findings of separate reviews to be compared and contrasted and thereby provide decision makers in healthcare with the evidence they need. |
| Methods | We included SRs evaluating pharmacological and nonpharmacological interventions for CU. Comprehensive searches were conducted in 7 bibliographic databases, relevant journals up to July 2018. Two reviewers independently assessed the studies' relevance and quality. The assessment of multiple systematic reviews tool and grading of recommendations assessment, development and evaluation method was used to assess the methodological quality of the SRs and classify the quality of the outcomes. |
| Results | In total, 41 SRs were included. Thirty-seven reviews performed quantitative research syntheses, and 4 reviews performed qualitative research syntheses. The majority of SRs evaluated interventions based on combination therapies, antihistamines, traditional Chinese medicines, autohemotherapy, omalizumab, acupuncture, cyclosporine, and leukotriene receptor antagonist. Positive intervention outcomes were reported in the majority (75.32%) of the reviews. However, the methodological quality and evidence quality of the reviews were generally poor. There is some evidence to support a variety of interventions for CU. However, there was much heterogeneity in evidence quality among SRs. Many of the SRs had methodological weaknesses that make them vulnerable to bias. Moreover, there remained little information on the relative effectiveness of one intervention compared with another. Therefore, further SRs that adherence to strict scientific methods are necessary, and primary studies make comparisons between the different treatment options directly. |
3. Clinical Practice Guidelines
| ⊕ positive recommendation (regardless of the level of evidence reported) Ø negative recommendation (or lack of evidence) |
3.1. American Academy of Allergy, Asthma & Immunology (AAAAI), The American College of Allergy, Asthma & Immunology (ACAAI) (USA, 2014) Ø
Bernstein JA, Lang DM, Khan DA, Craig T, Dreyfus D, Hsieh F, Sheikh J, Weldon D, Zuraw B, Bernstein DI, Blessing-Moore J, Cox L, Nicklas RA, Oppenheimer J, Portnoy JM, Randolph CR, Schuller DE, Spector SL, Tilles SA, Wallace D. The diagnosis and management of acute and chronic urticaria: 2014 update. J Allergy Clin Immunol. 2014 May;133(5):1270-7. https://doi.org/10.1016/j.jaci.2014.02.036
| Other unproved therapies for CU that are NOT recommended include allergen immunotherapy, herbal therapies, vitamins, supplements, and acupuncture. (C) |
