International Evidence-Based Guidelines for Traditional Chinese Medicine Management of Allergic Rhinitis.

BACKGROUND Allergic rhinitis (AR) is a prevalent chronic condition that significantly impacts patients' quality of life and poses challenges to effective management. Traditional Chinese medicine (TCM) offers a holistic approach, emphasizing syndrome differentiation, individualized care, and natural treatment strategies. OBJECTIVE To develop comprehensive evidence-based guidelines for AR management using TCM interventions, incorporating rigorous evidence assessment and expert consensus. METHODS The guidelines were developed using the GRADE-TCM framework, analyzing 351 randomized controlled trials (RCTs) involving 43,276 participants. Supplementary evidence from published textbooks, standardized documents, ancient literature, and TCM medical records was incorporated. Five rounds of expert consensus, involving 80 expert person-times and over 10,000 valid responses, refined the recommendations. RESULTS The guidelines provide 32 recommendations covering four primary TCM syndromes (Deficiency-cold of Lung Qi, Spleen Qi Deficiency and Weakness, Kidney-yang Deficiency, and Latent Heat in Lung Meridian) which are mainly involved in AR. These recommendations include both internal interventions (such as herbal and patent medicines) and external therapies (such as acupuncture, moxibustion, and other acupoint-based treatment). Of these interventions, 10 received strong recommendations, while 22 were classified as weak recommendations. TCM treatments demonstrated significant efficacy in alleviating AR symptoms, reducing recurrence, and improving quality of life. Additionally, TCM can complement conventional AR treatments by reducing the need for pharmacological therapy while maintaining a favorable safety profile. CONCLUSION The guidelines integrate classical TCM principles with modern evidence-based methodologies, offering a structured framework for AR management. They serve as clinical references for practitioners worldwide, supporting a promising approach to AR treatment. Future updates will incorporate emerging evidence and real-world clinical data to further optimize the role of TCM in AR management.