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

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