# Efficacy and safety of acupuncture for chronic spontaneous urticaria: a systematic review and meta-analysis

## TL;DR

This study finds acupuncture may be more effective than antihistamines for treating chronic hives, but more research is needed.

## Contribution

A systematic review and meta-analysis showing acupuncture's potential efficacy over antihistamines for chronic spontaneous urticaria.

## Key findings

- Acupuncture improved clinical effective rate and immune markers compared to antihistamines.
- Acupuncture reduced quality-of-life impact and recurrence rates in chronic urticaria patients.
- No significant difference in adverse events between acupuncture and antihistamine groups.

## Abstract

This systematic review and meta-analysis aimed to evaluate the efficacy and safety of acupuncture in the treatment of chronic spontaneous urticaria (CSU).

Randomized controlled trials (RCTs) assessing acupuncture for CSU were retrieved from seven public databases up to March 2025. Meta-analyses were conducted for each outcome, and publication bias and the certainty of evidence were evaluated.

Eight RCTs involving 564 participants were included. Compared with antihistamines, acupuncture significantly improved the clinical effective rate (RR 1.19, 95% CI 1.10–1.29, p < 0.0001) and interferon-γ levels (MD 5.96, 95% CI 3.92–8.00, p < 0.00001). Acupuncture also significantly reduced the Dermatology Life Quality Index (DLQI) score (MD −3.39, 95% CI − 6.53 to −0.26, p = 0.03), immunoglobulin E levels (MD −13.95, 95% CI − 17.20 to −10.70, p < 0.00001), interleukin-4 levels (MD −6.24, 95% CI − 6.82 to −5.67, p < 0.00001), and the recurrence rate (RR 0.25, 95% CI 0.01–0.62, p = 0.003). The incidence of adverse events did not differ significantly between groups (RR 0.80, 95% CI 0.23–2.80, p = 0.73). Potential publication bias was observed for the clinical effective rate and DLQI.

Compared with antihistamines, acupuncture may be a more effective alternative treatment for CSU. However, as the certainty of evidence was low, these findings require further validation.