Acupuncture for seasonal allergies is an increasingly popular complementary approach among people seeking relief from hay fever symptoms such as sneezing, nasal congestion, and itchy eyes. Rooted in traditional Chinese medicine, acupuncture involves the insertion of fine sterile needles into specific points on the body and is thought to influence immune and inflammatory responses. Whilst it is not recommended as a first-line treatment within UK clinical guidelines, growing patient interest and an expanding evidence base have prompted closer examination of its role alongside conventional antihistamine therapy. This article explores the evidence, what to expect from treatment, safety considerations, and how acupuncture fits within a broader allergy management plan.

How Acupuncture May Help With Seasonal Allergies

Acupuncture is thought to reduce hay fever symptoms by modulating histamine release, cytokine activity, and the HPA axis, though these mechanisms remain theoretical and are not established in humans.

Acupuncture is a practice rooted in traditional Chinese medicine that involves the insertion of fine, sterile needles into specific points on the body, known as acupoints. In the context of seasonal allergies — commonly referred to as hay fever or allergic rhinitis — acupuncture is thought to work through several proposed mechanisms that may modulate immune and inflammatory responses.

From a biomedical perspective, some laboratory and early clinical research suggests that acupuncture may influence the release of neuropeptides and cytokines, and may affect the hypothalamic-pituitary-adrenal (HPA) axis, which plays a role in regulating inflammation and stress responses. Stimulation of certain acupoints has also been proposed to reduce histamine release from mast cells, potentially alleviating symptoms such as sneezing, nasal congestion, and itchy eyes. It is important to note that these mechanisms remain theoretical or of low certainty in humans; they are based largely on laboratory studies and small clinical investigations, and should not be interpreted as established fact. There is currently no evidence that acupuncture modifies the natural history of allergic rhinitis or produces disease-modifying effects.

Acupuncture is not a first-line treatment for seasonal allergies within UK clinical guidelines (NICE CKS: Allergic Rhinitis). However, interest in acupuncture as a complementary approach has grown, particularly among patients seeking adjuncts to conventional antihistamine therapy.

Acupuncture is not statutorily regulated in the UK. When seeking treatment, patients are advised to choose a practitioner registered with a Professional Standards Authority (PSA)-accredited register — such as the British Acupuncture Council (BAcC) — or a statutorily regulated healthcare professional (for example, a physiotherapist or doctor) who has undertaken additional acupuncture training. It is also advisable to check that the premises hold the appropriate local authority licence for skin-piercing activities.

What the Clinical Evidence Says About Acupuncture and Hay Fever

The 2015 Cochrane Review and the ACUSAR trial found modest but statistically significant improvements in nasal symptoms and quality of life, though evidence quality is moderate and UK guidelines do not recommend acupuncture for routine use.

The clinical evidence base for acupuncture in seasonal allergic rhinitis has expanded over the past two decades, though important uncertainties remain.

A landmark randomised controlled trial — the ACUSAR trial (Brinkhaus et al., Annals of Internal Medicine, 2013) — enrolled over 400 participants and found that patients receiving acupuncture alongside antihistamines reported greater improvements in rhinitis symptom scores and rhinoconjunctivitis-specific quality of life compared with those receiving antihistamines alone or sham acupuncture. The between-group differences, while statistically significant, were modest in absolute terms, and the trial's follow-up period was limited.

A Cochrane systematic review (Feng et al., Cochrane Database of Systematic Reviews, 2015) examined multiple randomised controlled trials and concluded that acupuncture demonstrated a statistically significant benefit over sham acupuncture for nasal symptom scores, rhinoconjunctivitis quality-of-life measures, and reduction in antihistamine use. However, the authors rated the overall quality of evidence as moderate, noted considerable heterogeneity between trials, and concluded that further high-quality trials were needed to confirm long-term efficacy and to establish optimal treatment protocols. The durability of benefit beyond the active treatment period remains uncertain.

In the UK, NICE does not currently recommend acupuncture specifically for allergic rhinitis (NICE CKS: Allergic Rhinitis). The British Society for Allergy and Clinical Immunology (BSACI) guideline on allergic rhinitis similarly does not include acupuncture within its recommended treatment pathway. European guidance (ARIA/EAACI) acknowledges that some evidence exists for acupuncture as a complementary option but does not recommend it for routine use, emphasising that evidence remains insufficient to replace established pharmacological treatments.

Patients should be encouraged to discuss acupuncture with their GP or allergy specialist before commencing treatment, particularly if symptoms are severe, poorly controlled, or associated with comorbid asthma.

What to Expect During an Acupuncture Session for Allergies

A typical course involves 6–12 weekly sessions using sterile single-use needles retained for 20–30 minutes; treatment protocols vary and there is no consensus on optimal frequency or duration.

For those considering acupuncture for seasonal allergies, understanding what a typical session involves can help manage expectations and reduce any apprehension.

An initial consultation with a qualified acupuncturist will usually last between 60 and 90 minutes. During this appointment, the practitioner will take a detailed health history, including the nature and severity of allergy symptoms, any medications being taken, and relevant lifestyle factors.

Treatment involves the insertion of very fine, single-use sterile needles into specific acupoints. For allergic rhinitis, commonly used points include those located around the nose, face, hands, and lower legs — such as LI4 (Hegu), ST36 (Zusanli), and LU7 (Lieque) — which are traditionally associated with respiratory and immune function. Needles are typically retained for 20 to 30 minutes per session, during which most patients report a mild sensation of heaviness, tingling, or warmth at the needle site, often described as de qi.

A typical course of treatment for seasonal allergies may involve 6 to 12 sessions, often scheduled weekly or twice weekly, ideally beginning several weeks before the anticipated allergy season. It should be noted that treatment protocols vary considerably between practitioners, and there is currently no consensus on the optimal number, frequency, or duration of sessions. Maintenance treatment is sometimes recommended, though evidence supporting this is limited.

Access to acupuncture on the NHS is very limited; most patients in the UK self-fund treatment. Patients should ensure their acupuncturist is registered with a PSA-accredited register (such as the BAcC) or is a statutorily regulated healthcare professional with additional acupuncture training, and that the treatment premises hold the appropriate local authority licence for skin-piercing activities. Further guidance on finding a qualified practitioner is available on the NHS 'Acupuncture' page.

Safety Considerations and Who Should Seek Medical Advice First

Acupuncture is generally safe with a trained practitioner, but people who are pregnant, anticoagulated, immunocompromised, or have a pacemaker should seek GP advice before starting treatment.

Acupuncture is generally considered safe when performed by a trained and registered practitioner using sterile, single-use needles. Serious adverse events are rare; however, patients should be informed of both common minor side effects and very rare but serious complications before commencing treatment.

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Common minor side effects may include:

• Mild bruising or bleeding at needle insertion sites

• Temporary soreness or aching around acupoints

• Lightheadedness or dizziness, particularly after the first session

• Fatigue in the hours following treatment

Very rare but serious complications — including pneumothorax (collapsed lung), deep infection, and injury to underlying structures — have been reported, particularly when needles are inserted in the chest or upper back region. Patients should seek immediate medical attention (call 999 or go to A&E) if they experience chest pain or breathlessness during or after a session.

Certain individuals should seek medical advice from their GP before pursuing acupuncture. This includes people who:

• Are pregnant (some acupoints are contraindicated in pregnancy)

• Have a bleeding disorder or are taking anticoagulant medications such as warfarin or apixaban

• Have a pacemaker (if electroacupuncture is being considered)

• Have active skin infections or conditions affecting the proposed needle sites

• Are immunocompromised, including those on immunosuppressant therapy

Patients with severe or uncontrolled allergic rhinitis, or those who have previously experienced anaphylaxis, should always consult an allergy specialist before exploring complementary therapies. Acupuncture does not treat anaphylaxis and must never be used as a substitute for prescribed emergency medication such as an adrenaline auto-injector (e.g., EpiPen, Jext, or Emerade).

If symptoms worsen significantly during or after a course of acupuncture, or if new symptoms develop, patients are advised to contact their GP promptly. All treating clinicians — including GPs and allergy specialists — should be informed that acupuncture is being undertaken, to ensure coordinated and safe care.

Suspected adverse effects or incidents involving medical devices used during acupuncture (such as needles) can be reported via the MHRA Yellow Card Scheme at yellowcard.mhra.gov.uk or via the Yellow Card app.

Combining Acupuncture With Conventional Allergy Treatments

Acupuncture can be used alongside standard NHS treatments such as antihistamines and intranasal corticosteroids; low-to-moderate evidence suggests combining both may improve symptom relief and reduce antihistamine use.

One of the more practical aspects of acupuncture for seasonal allergies is that it can generally be used alongside conventional pharmacological treatments, making it a complementary rather than alternative approach.

Standard NHS-recommended treatments for allergic rhinitis include non-sedating oral antihistamines (such as cetirizine or loratadine), intranasal corticosteroid sprays (such as beclometasone or fluticasone), intranasal antihistamines (such as azelastine), and combination intranasal corticosteroid/antihistamine sprays (such as fluticasone/azelastine) for moderate-to-severe symptoms. Sodium cromoglicate eye drops may be used for ocular symptoms. Nasal decongestant sprays can provide short-term relief but should not be used for more than seven days continuously, as prolonged use can cause rebound congestion (rhinitis medicamentosa). In more severe or persistent cases, NICE guidance and the BSACI guideline support referral for allergen immunotherapy (desensitisation), which remains the only disease-modifying treatment currently available for allergic rhinitis.

The ACUSAR trial and the 2015 Cochrane Review suggest, with low-to-moderate certainty, that combining acupuncture with antihistamines may produce greater symptom relief than antihistamines alone, and may reduce the overall quantity of antihistamine medication required. This is particularly relevant for patients who experience side effects from antihistamines or who prefer to minimise medication use where possible. The duration and long-term sustainability of this benefit remain uncertain.

Patients should be transparent with both their GP and their acupuncturist about all treatments being used, including over-the-counter remedies and supplements. There is no known pharmacological interaction between acupuncture and standard allergy medications, but open communication supports safe, integrated care.

Lifestyle measures — such as monitoring pollen forecasts (available via the Met Office), wearing wraparound sunglasses outdoors, showering and changing clothes after time outside, and keeping windows closed during high-pollen periods — remain important adjuncts regardless of treatment approach, as recommended by NHS guidance on hay fever.

Patients should seek prompt review from their GP or an allergy specialist if symptoms remain poorly controlled despite optimal treatment, if allergic rhinitis is significantly affecting sleep, work, or school, if there is comorbid or poorly controlled asthma, or if there are features suggesting nasal polyps, unilateral nasal obstruction, recurrent nosebleeds, or occupational rhinitis. In summary, acupuncture represents a reasonable complementary option for motivated patients with seasonal allergic rhinitis, particularly those with mild-to-moderate symptoms, and should be pursued under the guidance of a qualified practitioner and in conjunction with — rather than instead of — evidence-based conventional care.

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