Acupuncture for chronic urticaria: a systematic review and meta-analysis with trial sequential analysis

Area of Science:

• Integrative and Complementary Medicine
• Dermatology
• Clinical Research Methodology

Background:

• Chronic urticaria (CU) significantly impairs patients' quality of life due to recurrent wheals and itching.
• Evaluating acupuncture's efficacy and safety for CU is crucial for informed clinical practice.
• Meta-analysis and trial sequential analysis (TSA) provide robust evidence synthesis.

Purpose of the Study:

• To assess the efficacy and safety of acupuncture for chronic urticaria (CU).
• To compare acupuncture against Western medicine (WM), sham acupuncture (SA), and waitlist control (WC).
• To provide evidence for clinical decision-making regarding acupuncture in CU management.

Main Methods:

• Systematic literature search across multiple databases up to September 2025.
• Inclusion of 18 randomized controlled trials (1,829 patients) comparing acupuncture with WM, SA, or WC.
• Meta-analysis, trial sequential analysis (TSA), and GRADE assessment for evidence quality and conclusion stability.

Main Results:

• Acupuncture significantly reduced the Weekly Urticaria Activity Score (UAS7) compared to SA and WC, but not WM.
• Acupuncture significantly improved the Dermatology Life Quality Index (DLQI) compared to WM, SA, and WC.
• Evidence for reduced UAS7 and DLQI is conclusive via TSA; evidence for improved IgE levels is inconclusive. Adverse events like ecchymosis and pain were more frequent with acupuncture.

Conclusions:

• Acupuncture is a potential therapeutic intervention for chronic urticaria (CU).
• It effectively reduces urticarial episodes and improves patient-reported symptoms and quality of life.
• Further research is needed to clarify its impact on serum IgE levels and optimize safety profiles.