Efficacy and safety of acupuncture therapy for chronic spontaneous urticaria: a network meta-analysis based on randomized controlled trials.

BACKGROUND

Chronic spontaneous urticaria (CSU) is a common refractory skin disorder impairing quality of life. This study systematically evaluated the clinical efficacy and safety of acupuncture therapies for CSU, providing evidence for clinical decision-making.

METHODS

Eight databases-CNKI, VIP, WanFang, SinoMed, PubMed, Embase, Cochrane Library, and Web of Science-were searched from their inception to 31 July 2025, for randomized controlled trials (RCTs) investigating various acupuncture therapies for CSU. The quality of the included studies was assessed using the Risk of Bias 2 tool. Data analysis was performed using R4.4.2 and Stata 18. This study was registered in PROSPERO (https://www.crd.york.ac.uk/PROSPERO/view/CRD42024608056).

RESULTS

Ninety-three RCTs involving 7,746 patients were included. Based on surface under the cumulative ranking curve (SUCRA) analysis, acupuncture combined with autohemotherapy ranked first in improving efficacy [SUCRA = 92.79%, relative risk (RR) = 1.46, 95% credible interval (CrI): 1.19, 1.84]. Moxibustion ranked first in reducing the Dermatology Life Quality Index (DLQI) score [SUCRA = 99.94%, mean difference (MD) = -9.45, 95% CrI: -12.48, -6.44]. In terms of wheal count, most pairwise comparisons among interventions showed no significant differences, and none of the acupuncture therapies demonstrated statistical superiority over antihistamines. Acupuncture combined with moxibustion ranked first in reducing the severity of pruritus (SUCRA = 96.27%, MD = -1.03, 95% CrI: -1.15, -0.91). Autohemotherapy combined with moxibustion ranked first in reducing the levels of immunoglobulin E (IgE) (SUCRA = 93.05%, MD = -36.23, 95% CrI: -55.33, -17.33). The combination of acupuncture, bloodletting puncture and cupping (BLP-C), and antihistamine ranked first in both reducing interleukin-4 (SUCRA = 97.95%, MD = -194.39, 95% CrI: -317.68, -71.10) and increasing IFN-γ (SUCRA = 99.78%, MD = 32.36, 95% CrI: 19.00, 46.49). Acupuncture combined with cupping therapy ranked first in reducing the incidence of adverse reactions (SUCRA = 91.69%, RR = 0.04, 95% CrI: 0.04, 0.24) and relapse rate (SUCRA = 91.79%, RR = 0.02, 95% CrI: 0, 0.09).

CONCLUSION

Acupuncture therapies demonstrate good efficacy and safety in treating CSU. Nevertheless, optimal interventions should be selected based on the characteristics of symptoms, immune profiles, and patient tolerability. These findings should be interpreted cautiously and validated in larger, higher-quality trials due to study limitations.

SYSTEMATIC REVIEW REGISTRATION: identifier CRD42024608056.