To the Editor: Xue and colleagues reported an interesting randomised, single-blind trial of acupuncture for persistent allergic rhinitis (PAR) and concluded that acupuncture is an effective treatment for this condition.1 I am not entirely sure that this is true. The authors state that “once needling sensation (known as de-qi) was obtained, the needles were manipulated . . .”. In the sham group they inserted needles at non-acupuncture points where, according to acupuncture theory, no de-qi can be elicited. Thus the intervention patients were experiencing de-qi, and the control patients were not. This means that neither the patients nor the therapist were blinded. Consequently, the difference in outcome between the two groups could be unrelated to acupuncture itself, and caused by patient expectation, therapist expectation or both.

In addition, the statement of Xue et al that “no other randomised controlled trial of acupuncture in adults with PAR has been reported in the English medical literature”1 was misleading. Our review of this topic2 included no fewer than six randomised controlled trials, all either published in English or, in one case, with an English abstract. Interestingly, three of them suggested acupuncture to be effective, while three failed to do so. I fear that the study by Xue et al does little to resolve this intriguing discrepancy.

In reply: Ernst is concerned about the sham acupuncture procedure used in our trial.1 Although not universally agreed, the sham/placebo control we adopted has been described as best practice.2,3 The assumption that, without de-qi, participants would not be blinded is not supported by the literature. In fact, a sham procedure without de-qi was used in a recent trial reported by Ernst and colleagues on acupuncture for subacute stroke rehabilitation.4 In that study, as in ours, to increase the credibility of blinding, participants with previous experience of acupuncture were excluded, and those assessing the outcomes of treatment were blinded.

With regard to previous randomised controlled trials of acupuncture for adults with persistent allergic rhinitis in the English medical literature, Ernst failed to distinguish between seasonal allergic rhinitis (SAR) and persistent allergic rhinitis (PAR).5 Of the six studies included in his review,5 five were on SAR, and the sixth, which was cited in our report (reference 14), was on children with PAR. These reports, therefore, are not inconsistent with our findings.