Reply to: “Methodological Considerations for Sphenopalatine Ganglion Needling Trials in Allergic Rhinitis: Aligning Controls, Strengthening Physiologic Endpoints, and Extending Safety Assessment”

To the Editor: We sincerely thank Dr. Hong for his thoughtful commentary on our recent article, “Acupuncture Combined With Sphenopalatine Ganglion Needling for Allergic Rhinitis: A Randomized Controlled Trial” [1], and appreciate the opportunity to respond. Our multicenter randomized trial compared acupuncture (ACU), sphenopalatine ganglion needling (SPG-N), their combination (COM), and oral loratadine (MED) in patients with persistent moderate-to-severe allergic rhinitis. The primary finding was that COM provided more rapid and robust symptom relief than MED, supporting its potential as a non-pharmacologic treatment option. Regarding the placebo effect and control group design, we explicitly acknowledged in both the Introduction, Discussion, and Limitation sections of the original manuscript that this study lacked sham acupuncture controls and formal blinding assessment, making it difficult to fully distinguish the specific therapeutic effects of acupuncture from nonspecific placebo effects [2]. As the first large-scale multicenter RCT to validate the efficacy of this combined therapy, the primary objective of this study was to provide high-level evidence for clinical practice and lay the groundwork for future, more rigorous sham-controlled mechanistic studies. Concerning the incorporation of objective measurements, such as nasal airflow function tests [3], we recognize their significant value for future research. This study primarily employed internationally recognized subjective symptom and quality-of-life scales for evaluation, which are core indicators for assessing AR treatment efficacy [4, 5]. The inclusion of objective metrics will be an important direction for subsequent mechanistic investigations. We place high importance on the safety of SPG needling. We provided detailed reporting of all adverse events (all of which were mild and self-limiting) and acknowledged in the Limitations section that the 4-week follow-up period is relatively short for chronic AR [6]. More extensive long-term safety and durability assessments are indeed areas for future research to strengthen. We thank Dr. Hong for his constructive comments, which provide important guidance for future research. We will continue to advance exploration in this field and are committed to further clarifying its clinical value and mechanisms of action through more refined research designs.