Acupuncture compared with oral antihistamine for type I hypersensitivity itch and skin response in adults with atopic dermatitis – a patient‐ and examiner‐blinded, randomized, placebo‐controlled, crossover trial

Background Itch is the major symptom of atopic dermatitis ( AD ). Acupuncture has been shown to exhibit a significant effect on experimental itch in AD . Our study evaluated acupuncture and antihistamine itch therapy (cetirizine) on type I hypersensitivity itch and skin reaction in AD using a patient and examiner‐blinded, randomized, placebo‐controlled, crossover trial. Methods Allergen‐induced itch was evaluated in 20 patients with AD after several interventions in separate sessions: preventive (preceding) and abortive (concurrent) verum acupuncture ( VA p and VA a), cetirizine (10 mg, VC ), corresponding placebo interventions (preventive, PA p, and abortive, PA a, placebo acupuncture; placebo cetirizine pill, PC ) and a no‐intervention control ( NI ). Itch was induced on the forearm and temperature modulated over 20 min, using our validated model. Outcome parameters included itch intensity, wheal and flare size and the D 2 attention test. Results Mean itch intensity ( SE : 0.31 each) was significantly lower following VA a (31.9) compared with all other groups ( PA a: 36.5; VC : 36.8; VA p: 37.6; PC : 39.8; PA p: 39.9; NI : 45.7; P  < 0.05). There was no significant difference between VA p and VC ( P  > 0.1), although both therapies were significantly superior to their respective placebo interventions ( P  < 0.05). Flare size following VA p was significantly smaller ( P  = 0.034) than that following PA p. D 2 attention test score was significantly lower following VC compared with all other groups ( P  < 0.001). Conclusions Both VA and cetirizine significantly reduced type I hypersensitivity itch in patients with AD , compared with both placebo and NI . Timing of acupuncture application was important, as VA a had the most significant effect on itch, potentially because of counter‐irritation and/or distraction. Itch reduction following cetirizine coincided with reduced attention.