Allergic rhinitis (AR) is a disorder that affects more than 500 million people worldwide. Nasal congestion is one of the most general and bothersome symptoms in rhinitis, which impacts the quality of life (QOL). Current medications are undesirable due to their side-effects and there are AR patients who perceive inadequate responses despite to advancements in conventional medicine. Acupuncture for AR in general can be considered as safe and can be seen as a potential therapeutic intervention for nasal congestion. Evidence supported that acupuncture is clinically used for signs and symptoms of nose disorders, such as nasal congestion, with effectiveness, but whether acupuncture has immediate, post-treatment and long-term effects on nasal congestion in AR is not verified by strictly designed clinical study. The ANCAR trial uses a standard treatment protocol with a fixed set of acupuncture points - to be as scientific as possible from Western medical viewpoint - to open the nose and affect underlying energetic imbalance and immunity at the same time, to maintain its nose opening effect. This novel acupuncture treatment protocol can be seen as a solid and profound approach from which every AR patient may benefit.

Worldwide more than approximately 500 million people suffer from AR (30% of the Dutch population) and its prevalence is expanding. Nasal congestion (i.e. reversible mucosal congestion/nasal mucosal obstruction) is one of the most general and bothersome symptoms in rhinitis and is associated with other medical conditions such as rhinosinusitis and otitis media. This study is relevant as in addition to the high global occurrence of AR, this disorder has substantial effects on the quality of life (QOL) (e.g. during sleep and work). AR is related to high direct medical costs (mainly prescription of medications and outpatient visits) and indirect economic costs (including productivity decrease). Current medications are undesirable due to their side-effects (such as sedation in the case of intranasal antihistamines (INAH)) and there are AR patients who perceive inadequate responses despite to advancements in conventional medicine.

Acupuncture for AR in general can be considered as safe and can be seen as a potential therapeutic intervention for nasal congestion. Evidence supported that acupuncture is clinically used for signs and symptoms of nose disorders, such as nasal congestion, with effectiveness, but whether acupuncture has immediate, post-treatment and long-term effects on specifically nasal congestion in AR is not verified by strictly designed clinical study. The ANCAR trial aims to evaluate the effects of an acupuncture treatment protocol for nasal congestion in AR compare to azelastine nasal spray (Carelastin®). A standard treatment protocol with a fixed set of acupuncture points has been established - to be as scientific as possible from Western medical viewpoint - and this selection of acupuncture points can be seen as a solid and profound approach from which every AR patient may benefit. This standard set opens the nose and affects the underlying energetic imbalance and immunity at the same time to maintain its nose opening effect (i.e. to prevent recurrence of the complaint). The acupuncture protocol concerns 8 treatments during 6 weeks (i.e. 2 treatments per week during the first 2 weeks and 1 treatment per week in the consecutive 4 weeks).

The positive effects of this treatment protocol (such as improvement QOL) may result in more confidence in the direct, post-treatment and long-term effects of acupuncture and lead to more acceptance of acupuncture as a solid treatment option for nasal congestion in AR instead of using an INAH spray.

Hypothesis: Acupuncture will improve nasal congestion in AR compare to azelastine nasal spray (Carelastin®).

Objective: To evaluate the effects of an acupuncture treatment protocol for nasal congestion in AR.

Inclusion Criteria:

• Diagnosed AR by a physician
• Have one of the AR types: seasonal (SAR) or perennial (PAR) or mixed (MAR) allergic rhinitis
• VAS nasal congestion: 3-10
• Age: from 18 years
• Signed Informed Consent

Exclusion Criteria:

• COVID-19
• Acute common cold
• Influenza
• Fever (38°C or higher)
• Acute nasal trauma (such as a fracture and epistaxis)
• Irreversible nasal blockages (such as septum deviation, concha bullosa, polyps and cysts)
• Nasal and sinus cancer
• Pregnancy or planning for pregnancy
• Consumed decongestions, antihistamines, antibiotics or corticosteroids within 2 weeks before the RCT
• Received acupuncture, Chinese herbal medicine or another complementary treatment within 2 weeks before the RCT
• Received immunotherapy within 2 weeks before the RCT
• Participants refusing or unable to sign Informed Consent

IPD that underlies the results reported in this article after deidentification (text, tables, figures and appendixes) for qualified researchers. Approval of the request is a prerequisite to the sharing of data.

3 months following publication, ending 3 years following article publication.

Access to trial IPD can be requested by a qualified researcher engaging in independent scientific research.

One subject withdrew before treatment protocol started.

Adverse event data were collected from registration through the 2-month follow-up period after the primary endpoint assessment at week 6 (up to approximately 3.5 months; average of 14 weeks).

The ANCAR trial encountered crucial recruitment challenges mainly due to COVID-19 pandemic and the fact that acupuncture is not part of regular medicine in The Netherlands , leading to a much lower patient count than initially anticipated.