QUOTE: https://www.guideline.gov/summaries/summary/49010

Clinical practice guideline: Allergic rhinitis.

Seidman MD1, Gurgel RK2, Lin SY3, Schwartz SR4, Baroody FM5, Bonner JR6, Dawson DE7, Dykewicz MS8, Hackell JM9, Han JK10, Ishman SL11, Krouse HJ12, Malekzadeh S13, Mims JW14, Omole FS15, Reddy WD16, Wallace DV17, Walsh SA18, Warren BE18, Wilson MN19, Nnacheta LC20; Guideline Otolaryngology Development Group. AAO-HNSF.

Clinicians may offer acupuncture, or refer to a clinician who can offer acupuncture, for patients with AR who are interested in nonpharmacologic therapy. Option based on RCTs with limitations, observational studies with consistent effects, and a preponderance of benefit over harm.

Action Statement Profile

●Quality improvement opportunity: To promote a consistent and systematic approach to initial evaluation of the patient with AR

●Aggregate evidence quality: Grade C, based on observational studies

●Level of confidence in evidence: High

●Benefits: Avoid unnecessary treatment or testing, time referrals appropriately, institute a specific therapy, improve quality of life and productivity, improve accurate diagnosis

●Risks, harms, costs: Inappropriate treatment, potential misdiagnosis from using history and physical alone

●Benefit-harm assessment: Preponderance of benefit over harm

●Value judgments: Although the Guideline Development Group recognized that a conclusive diagnosis of AR is difficult without diagnostic testing, making a presumptive diagnosis of AR based on history and physical examination alone is reasonable.

●Intentional vagueness: The use of the words "clinical diagnosis" acknowledges that this is a presumptive diagnosis not confirmed with testing. The use of the words "when patients present with a history and physical examination consistent with an allergic cause" assumes that a clinician will know how to make an appropriate diagnosis of AR. Specifics of what constitutes a history and physical examination consistent with an allergic cause are provided in the supporting text in the original guideline document.

●Role of patient preferences: Limited—Patient may request that additional testing be conducted before deciding on initiation of treatment.

●Exclusions: None

●Policy level: Recommendation

2015年美国耳鼻喉科学会发布的过敏性鼻炎最新临床实践指南指出：过敏性鼻炎临床医师可考虑使用针灸，针灸治疗的优势在于生活质量，检索药物的作用以及潜在的副作用。临床证据等级为B。基于有一定局限性的RCTs，效应一致的观察性研究，利大于弊。