Unveiling the Role of Intranasal Acupuncture in Orchestrating Biliverdin‐Driven Porphyrin Metabolism to Alleviate Allergic Rhinitis: A Metabolomic Research

This metabolomic study aimed to investigate the mechanism of intranasal acupuncture in treating allergic rhinitis (AR) by analyzing local metabolic changes in nasal secretions. Twenty AR patients (receiving 14 consecutive days of intranasal acupuncture) and 20 age- and gender-matched healthy controls were enrolled, with samples analyzed via ultraperformance liquid chromatography coupled with high-resolution mass spectrometry (UPLC-Q-Exactive-HRMS). Baseline comparisons identified 342 differential metabolites between AR patients and healthy controls. Biliverdin, a key intermediate in porphyrin metabolism, was significantly downregulated in AR patients (p < 0.05). After treatment, AR patients showed marked symptomatic improvement, as evidenced by reduced Total Nasal Symptom Score (TNSS), Visual Analog Scale (VAS), and Total Nonnasal Symptom Score (TNNSS), along with a significant rebound in biliverdin levels (p < 0.05). Metabolic pathway analysis revealed the porphyrin metabolic pathway was significantly enriched in both the comparison between AR patients and healthy controls and the comparison between posttreatment and pretreatment AR patients. These findings suggest intranasal acupuncture alleviates AR by regulating the abnormal expression of biliverdin in porphyrin metabolism and activating heme oxygenase-1 (HO-1)-mediated antioxidant and anti-inflammatory responses, highlighting biliverdin as a potential biomarker for AR diagnosis and treatment monitoring.