Potential effectiveness of Chinese herbal medicine Yu ping feng san for adult allergic rhinitis: a systematic review and meta-analysis of randomized controlled trials

Abstract

BackgroundChinese herbal medicine formula Yu ping feng san (YPFS) is commonly used for allergic rhinitis (AR). Previous review had summarized the effectiveness and safety of YPFS, however without any subgroup analysis performed to provide detailed evidence for guiding clinical practice. YPFS was recommended for the management of AR by Chinese medicine clinical practice guideline, but the treatment duration of YPFS was also not specified. The aim of this study is to evaluate the effectiveness and safety of YPFS in treating adult AR with the most recent evidence, and attempt to specify the duration of utilisation through subgroup meta-analyses.MethodsSeven databases were searched from their inceptions to September 2017. Randomized controlled trials (RCTs) evaluating YPFS for adult AR were included. Methodological quality of studies was assessed using the Cochrane risk of bias tool. Meta-analysis and subgroup meta-analyses were conducted for evaluating the effectiveness of YPFS. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used for rating the quality of evidence.ResultsTwenty-two RCTs involving 23 comparisons were included in this review. YPFS was compared to placebo, pharmacotherapy, and used as an add-on treatment compared to pharmacotherapy. Meta-analyses were feasible for the outcomes of four individual nasal symptom scores and “effective rate”. Four individual nasal symptom scores decreased after YPFS’ combination treatment: itchy nose (MD-0.46, 95% CI[−0.50, −0.42]), sneezing (MD-0.41, 95% CI[−0.47, −0.35]), blocked nose (MD-0.46, 95% CI[−0.54, −0.39]) and runny nose (MD-0.42, 95% CI[−0.58, −0.26]). Based on “effective rate”, meta-analysis showed that YPFS did not achieve better effect than pharmacotherapy (RR1.07, 95%CI [0.94, 1.22), but its combination with pharmacotherapy seemed more effective than pharmacotherapy alone (RR1.27, 95%CI [1.19, 1.34]) (low quality). Subgroup analysis suggested that YPFS was not superior to the second-generation antihistamine (RR1.04, 95%CI [0.90, 1.19]) (low quality). Further, YPFS’ combination treatment seemed more beneficial when it was used for more than three weeks (RR1.15, 95%CI [1.01, 1.32]). In addition, YPFS was well-tolerated for treating adult AR.ConclusionChinese herbal medicine formula YPFS seems beneficial for adult AR. This potential benefit need to be further evaluated by more rigorous RCTs.Electronic supplementary materialThe online version of this article (10.1186/s12906-017-1988-5) contains supplementary material, which is available to authorized users.

Rhinitis 2020: A practice parameter update

“…A review of one such CHM, Yu ping feng san, identified 22 randomized controlled trials (of 1244 records) with 2309 participants with AR. 557 Control groups included placebo, pharmacotherapy, and the combination of CHM and pharmacotherapy, and the treatment periods ranged from 2 to 8 weeks. Results were limited in the placebo-control trials and suggested a trend for benefit from CHM in a very small number of studies.…”

Okbyungpoongsan (Yupingfeng) for treating allergic rhinitis

“…OBPS has shown efficacy against allergic reactions and inflammation and thus has been applied to treat AR, COPD, asthma, and so on. [ 2 , 17 , 18 ] OBPS regulates inflammation processes by both boosting inflammation and suppressing inflammation. In detail, OBPS stimulates mRNA and protein expression of pro-inflammatory cytokines via NF-kB and suppresses mRNA and protein expression in a lipopolysaccharide (LPS)-induced chronic inflammation model.…”

“…There was 1 research article that was a systematic review and meta-analysis of RCTs. [ 2 ] This article included 22 RCTs, and OBPS was compared to placebo and pharmacotherapy. However, the study had some limitations, as mentioned in the article itself.…”

“…Additionally, itchy nose, sore throat, itchy eyes, watery eyes, cough, and headache are observed. [ 2 ] These symptoms tend to be more intense in spring and autumn. [ 3 ]…”

Effects of YuPingFeng granules on acute exacerbations of COPD: a randomized, placebo-controlled study

“… 14 – 17 Clinical studies have demonstrated that YuPingFeng powder reduces the risk of recurrent respiratory infections by regulating the immune system, 18 inhibiting inflammatory cytokines in vivo, 19 and by its anti-allergic effects. 20 Therefore, we hypothesized that YuPingFeng granules may be effective in treating COPD.…”