Abstract
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.