Traditional Chinese Medicine for Allergic Rhinitis: Mechanisms, Evidence, and Gut-Immune Axis Targets

Allergic rhinitis (AR) is a highly prevalent allergic disorder with increasing global incidence, and gut microbiota dysbiosis has emerged as a key pathogenic factor. This review systematically synthesizes evidence on how traditional Chinese medicine (TCM)-including single herbs, herbal formulas, and auxiliary therapies-alleviates AR by targeting gut microbiota, aiming to clarify mechanistic pathways and provide evidence-based support for clinical practice.

A comprehensive literature search was conducted in PubMed, China National Knowledge Infrastructure (CNKI), and Embase databases. Keywords included ["Traditional Chinese Medicine" or "TCM" or "Chinese herbal medicine" or "herbal formula"], ["allergic rhinitis" or "AR"], ["gut microbiota" or "intestinal microbiota"], ["immune regulation"], ["intestinal barrier"], and ["inflammatory mediator"]. Only peer-reviewed studies (human or animal models) focusing on TCM-gut microbiota-AR interactions were included; non-relevant, non-peer-reviewed, or duplicate articles were excluded.

A total of 210 relevant studies were initially identified from the three databases (PubMed: 67, Embase: 55, CNKI: 88); subsequently, 122 duplicate records, 44 irrelevant records (38 with title mismatch, 6 including meetings, case reports, and protocols), and 22 low-quality studies were excluded, and finally 24 studies were included in this review. TCM exerts anti-AR effects through multi-targeted modulation of the gut microbiota-intestinal barrier-immune axis. TCM (eg, Astragalus membranaceus, Xiaoqinglong Decoction) increases the abundance of beneficial bacteria (eg, Lactobacillus, Bifidobacterium) and reduces pathogenic taxa, while promoting the production of microbial metabolites like short-chain fatty acids (SCFAs). TCM components upregulate tight junction proteins (ZO-1, Occludin) and activate the PI3K/Akt pathway to enhance intestinal epithelial integrity, reducing barrier permeability. TCM balances Th1/Th2/Treg cell subsets, inhibits NLRP3 inflammasome-mediated pyroptosis, and reduces pro-inflammatory mediators (IL-4, IL-5, TNF-α) while elevating anti-inflammatory cytokines (IL-10, IFN-γ). Clinical trials confirm TCM alleviates AR symptoms (nasal congestion, rhinorrhea), lowers serum IgE levels, and reduces disease recurrence.

TCM ameliorates AR by integrating gut microbiota modulation, intestinal barrier repair, and immune regulation-highlighting its multi-pathway, multi-target advantages. Current limitations include insufficient large-scale randomized controlled trials and unclear TCM-microbiota crosstalk at the molecular level. Future research should leverage multi-omics technologies to decipher precise mechanisms and explore TCM-Western medicine combinations for optimized AR management.