To evaluate the efficacy and safety of intranasal acupuncture for allergic rhinitis (AR).

Randomized controlled trials on intranasal acupuncture for AR were searched in China National Knowledge Infrastructure, Wanfang Data Knowledge Service platform, VIP Database, PubMed, Web of Science, Embase, and The Cochrane Library from their inception to October 2024. The basic information, evaluation of the therapeutic efficacy, related scales, and laboratory indexes were screened and extracted by 2 independent reviewers. The scales included the Total Nasal Symptom Score (TNSS), the Total Nasal Symptom and Sneezing Score (TNNSS), Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Laboratory indicators focused on serum total IgE and serum interleukin-4 (IL-4) contents. Meta-analysis was conducted using RevMan software and Stata software.

A total of 19 randomized controlled trials involving 1482 participants were included. The Meta-analysis indicated that, compared with conventional western medicines and nasal-external acupuncture, the intranasal acupuncture group achieved greater reductions in TNSS [MD=-1.67, 95% CI (-2.30, -1.04), P<0.00001], RQLQ score [MD=-3.14, 95% CI (-4.16, -2.12), P<0.00001], and TNNSS [MD=-0.52, 95% CI (-0.67, -0.36), P<0.00001] from baseline to post-treatment, and greater decreases in serum IgE [SMD=-1.17, 95% CI (-1.46, -0.87), P=0.00001] and IL-4 [SMD=-1.14, 95% CI (-1.80, -0.49), P=0.0006] levels. Adverse events were mainly mild epistaxis and localized pain.

Intranasal acupuncture appears superior to nasal-external acupuncture and western medicines in reducing nasal symptom severity and improving life quality in AR, with no obvious adverse events reported. However, because the existing studies generally have small sample sizes, limited methodological rigor in randomized designs, and substantial heterogeneity across studies, the reliability of the findings is limited. Therefore, large-sample, multicenter, randomized controlled clinical trials are needed to improve the quality level of the evidence.