Review Article

Acupuncture and Related Therapies for Chronic Urticaria: A Critical Overview of Systematic Reviews

Table 6

Summary of evidence of included SRs.

Included studyOutcomesGRADE assessmentRelative effect (95% CI) valueCertainty
Risk of biasInconsistencyIndirectnessImprecisionPublication bias

Acupuncture or electroacupuncture VS Antihistamine

Li [24] (2009)Curing rateseriousNonoseriousstrongly suspectedRR = 2.14, 95%CI (1.64 to 2.79)VERY LOW
Yao [22] (2016)Total effective rateseriousNonoseriousstrongly suspectedRR = 1.37, 95%CI (1.11 to 1.70)VERY LOW
Yan [19] (2015)Total effective rateseriousNonoseriousstrongly suspectedRR = 1.21, 95%CI (1.00 to 1.46)VERY LOW
Zhao [40] (2019)Total effective rateseriousNonoseriousstrongly suspectedOR = 2.19, 95%CI (0.79 to 6.07)VERY LOW

Acupuncture or electroacupuncture combined with antihistamine VS Antihistamine

Li [24] (2009)Curing rateseriousNonoseriousstrongly suspectedRR = 2.03, 95%CI (1.35 to 3.06)VERY LOW
Recurrence rateseriousNononostrongly suspectedRR = 0.35, 95%CI (0.13 to 0.93)LOW
Yao [22] (2016)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.77, 95%CI (1.41 to 2.22)VERY LOW
Yan [19] (2015)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.20, 95%CI (1.07 to 1.35)VERY LOW
Zhao [40] (2019)Total effective rateseriousnonoseriousstrongly suspectedOR = 6.59, 95%CI (2.69 to 16.16)VERY LOW

Acupuncture combined with other therapies VS Antihistamine

Ke [25] (2021)Total effective rateseriousnonoseriousundetectedRR = 1.35, 95%CI (1.24 to 1.47)VERY LOW
Zhao [40] (2019)Total effective rateseriousnonoseriousstrongly suspectedOR = 4.35, 95%CI (2.41 to 7.86)VERY LOW
Curing rateseriousnonoseriousstrongly suspectedOR = 2.44, 95%CI (1.80 to 3.31)VERY LOW
IgEseriousnonoseriousstrongly suspectedSMD = -1.71, 95%CI (-2.12 to -1.29)VERY LOW
Recurrence rateseriousnonoseriousstrongly suspectedOR = 0.28, 95%CI (0.14 to 0.55)VERY LOW
Zhao [27] (2020)Total effective rateseriousnonoseriousstrongly suspectedRR = 3.85, 95%CI (2.61 to 5.69)VERY LOW
Recurrence rateseriousnononostrongly suspectedOR = 0.28, 95%CI (0.14 to 0.55)LOW

Acupuncture or Acupuncture combined with other therapies vs. Western medicine

Zhang [34] (2020)Total effective rateseriousnononoundetectedOR = 3.86, 95%CI (2.71 to 5.49)MODERATE
Recurrence rateseriousnononoundetectedOR = 0.34, 95%CI (0.16 to 0.72)MODERATE
Curing rateseriousnononoundetectedOR = 2.23, 95%CI (1.75 to 2.85)MODERATE

Bloodletting VS Antihistamine

Yao [20] (2019)Disease activity controlseriousnonoseriousstrongly suspectedMD = 0.67, 95%CI (0.03 to 1.31)VERY LOW
Total effective rateseriousnonoseriousstrongly suspectedRR = 1.10, 95%CI (0.97 to 1.26)VERY LOW

Bloodletting combined with antihistamine VS Antihistamine

Yao [20] (2019)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.34, 95%CI (1.10 to 1.63)VERY LOW

Cupping VS Antihistamine

Xiao [23] (2020)Total effective ratevery seriousseriousnoseriousundetectedRR = 1.10, 95%CI (0.97 to 1.25)VERY LOW
Recurrence ratevery seriousnonoseriousundetectedRR = 0.56, 95%CI (0.23 to 1.36)VERY LOW

Cupping combined with antihistamine VS Antihistamine

Xiao [23] (2020)Total effective ratevery seriousseriousnoseriousundetectedRR = 1.18, 95%CI (1.01 to 1.39)VERY LOW
Recurrence ratevery seriousnonoseriousundetectedRR = 0.52, 95%CI (0.32 to 0.84)VERY LOW

Cupping combined with acupuncture VS Acupuncture

Xiao [23] (2020)Total effective ratevery seriousseriousnoseriousundetectedRR = 1.25, 95%CI (1.07 to 1.46)VERY LOW

Autohemotherapy vs. Placebo

Liang [41] (2016)Total effective rateseriousvery seriousnoseriousstrongly suspectedRR = 1.51, 95%CI (1.06 to 2.14)VERY LOW

Autohemotherapy vs. Antihistamine

Luo [39] (2016)Total effective ratevery seriousseriousnoseriousstrongly suspectedRR = 1.05, 95%CI (0.97 to 1.13)VERY LOW
Clinical efficacy ratevery seriousseriousnoseriousstrongly suspectedRR = 1.12, 95%CI (0.98 to 1.28)VERY LOW
Liang [41] (2016)Total effective rateseriousvery seriousnoseriousstrongly suspectedRR = 1.14, 95%CI (1.04 to 1.26)VERY LOW
IgEseriousvery seriousnoseriousstrongly suspectedRR = -11.15, 95%CI (-55.62 to 33.32)VERY LOW
Zhao [30] (2019)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.28, 95%CI (1.17 to 1.40)VERY LOW
Curing rateseriousnonoseriousstrongly suspectedRR = 1.27, 95%CI (1.13 to 1.44)VERY LOW
Recurrence rateseriousnonoseriousstrongly suspectedRR = 0.34, 95%CI (0.26 to 0.46)VERY LOW

Autohemotherapy vs. Other treatment

An [38] (2016)Total effective ratevery seriousseriousnoseriousstrongly suspectedRR = 1.08, 95%CI (1.12 to 1.15)VERY LOW
Recurrence ratevery seriousseriousnoseriousstrongly suspectedRR = 0.46, 95%CI (0.26 to 0.81)VERY LOW
Luo [39] (2016)Total effective ratevery seriousseriousnoseriousstrongly suspectedRR = 1.07, 95%CI (0.88 to 1.29)VERY LOW
Clinical efficacy ratevery seriousseriousnoseriousstrongly suspectedRR = 1.36, 95%CI (0.95 to 1.96)VERY LOW
Pu [28] (2017)Clinical efficacy rateseriousnonoseriousstrongly suspectedRR = 1.13, 95%CI (1.07 to 1.19)VERY LOW
Recurrence rateseriousnonoseriousstrongly suspectedRR = 0.32, 95%CI (0.21 to 0.48)VERY LOW
Zhao [30] (2019)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.28, 95%CI (1.11 to 1.47)VERY LOW
Curing rateseriousnonoseriousstrongly suspectedRR = 1.33, 95%CI (1.05 to 1.69)VERY LOW

Autohemotherapy combined with antihistamine vs. Antihistamine

Yan [19] (2015)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.06, 95%CI (0.98 to 1.14)VERY LOW
Dermatology Quality Life Indexseriousnonoseriousstrongly suspectedMD = 0.90, 95%CI (1.34 to 0.46)VERY LOW
Luo [39] (2016)Recurrence ratevery seriousseriousnoseriousstrongly suspectedRR = 0.10, 95%CI (0.98 to 1.28)VERY LOW
Liang [41] (2016)Total effective rateseriousvery seriousnoseriousstrongly suspectedRR = 1.09, 95%CI (0.93 to 1.27)VERY LOW
Recurrence rateseriousnonoseriousstrongly suspectedRR = 0.36, 95%CI (0.23 to 0.55)VERY LOW
Wu [29] (2019)Total effective rateseriousseriousnoseriousundetectedRR = 1.25, 95%CI (1.19 to 1.32)VERY LOW
Recurrence rateseriousnonoseriousundetectedRR = 0.30, 95%CI (0.22 to 0.39)LOW

Autohemotherapy combined with herbal medicine vs. Herbal medicine

Yan [19] (2015)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.30, 95% CI (1.10, 1.55)VERY LOW
Luo [39] (2016)Total effective ratevery seriousseriousnoseriousstrongly suspectedRR = 1.30, 95% CI (1.10, 1.55)VERY LOW
Clinical efficacy ratevery seriousseriousnoseriousstrongly suspectedRR = 1.52, 95% CI (1.20, 1.94)VERY LOW

Catgut embedding vs. Other therapy

Wei [26] (2019)Clinical efficacy rateseriousnonoseriousstrongly suspectedRR = 1.1, 95% CI (1.03 to 1.16)VERY LOW
Curing rateseriousnonoseriousundetectedRR = 1.59, 95%CI (1.30 to 1.95)LOW
Recurrence rateseriousnonoseriousstrongly suspectedRR = 0.49, 95%CI (0.27 to 0.86)VERY LOW

Catgut embedding combined with antihistamine vs. Antihistamine

Yan [19] (2015)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.14, 95%CI (0.98 to 1.34)VERY LOW

Auriculotherapy or auriculotherapy combined with other therapies vs. Western medicine

Zhu [21] (2018)Improving clinical signs and symptomsseriousseriousnoseriousstrongly suspectedOR = 0.74, 95%CI (0.35 to 1.56)VERY LOW
Clinical efficacy rateseriousnonoseriousstrongly suspectedOR = 3.81, 95%CI (2.07 to 7.01)VERY LOW

Acupoint injection combined with western medicine vs. Western medicine

Yan [19] (2015)Total effective rateseriousnonoseriousstrongly suspectedRR = 1.07, 95%CI (0.99 to 1.17)VERY LOW

Note. CI, confidence interval; OR, odds ratio; RR, relative risk; MD, mean difference; SMD, standardized mean difference.