Objective To evaluate the clinical efficacy and safety of acupuncture at the sphenopalatine ganglion (SPG) for the treatment of allergic rhinitis (AR).

Methods A randomized controlled trial design was used. A total of 120 patients with AR were randomly assigned in a 1∶1 ratio to either the experimental group (acupuncture on the SPG, twice a week for 2 weeks) or the control group (oral lupatadine fumarate tablets, 10 mg daily for 2 weeks). The primary outcome measures were nasal symptom and sign scores at 1 and 2 weeks after treatment. Secondary outcome measures included the total non-nasal symptom score (TNNSS) and the rhinoconjunctivitis quality of life questionnaire (RQLQ) score.

Results Four cases were excluded from both the experimental group and the control group. Ultimately, 56 cases in each group completed the study. After two weeks of treatment, the total effective rates were 82.1% for the experimental group and 87.5% for the control group, with no statistically significant difference. At each time point after treatment, the symptom scores, sign scores, TNNSS, and RQLQ scores in both groups decreased compared to baseline, and these differences were statistically significant (P < 0.001). Generalized estimating equation (GEE) analysis showed that the improvement trends for most indicators were consistent between the two groups, but there was a "group × time" interaction, indicating that improvement in nasal congestion symptoms in the experimental group was greater than in the control group during the first week of treatment (experimental group: 2.0 1.0, 2.0 vs. control group: 2.0 1.0, 2.0, interaction P = 0.023). Forest plot analysis further showed that the standardized mean difference (SMD) for nasal congestion symptoms at one week of treatment was －0.420 (95% confidence interval: －0.795, －0.046), and the 95% confidence intervals for all indicators' SMD at two weeks crossed zero. Regarding safety, there was no statistically significant difference in the incidence of adverse events between the experimental and control groups.

Conclusion Acupuncture on the SPG and oral administration of lupatadine fumarate can both effectively alleviate symptoms and improve the quality of life for patients with AR. The overall short-term efficacy is comparable. However, acupuncture on the SPG is more effective in relieving nasal congestion and has a good safety profile.