Hindawi

Computational Intelligence and Neuroscience

Volume 2022, Article ID 6935758, 6 pages
https://doi.org/10.1155/2022/6935758

Research Article
Efficacy and Safety of Rupatadine Fumarate Combined with
Acupoint Application in Allergic Rhinitis
Complicated with Diabetes

Yu Liu,1 Pengjun Jiang,2 Xuqing Chen,3 Wen Zhang,3 and Jun Shi 3

1
Department of Otolaryngology,
Nanjing Integrated Traditional Chinese and Western Medicine Hospital Affiliated with Nanjing University of Chinese Medicine,
Nanjing 210014, China
2
Department of Hematology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China
3
Department of Otolaryngology, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, China

Correspondence should be addressed to Jun Shi; shishichuoshou@126.com

Received 7 March 2022; Revised 22 April 2022; Accepted 7 May 2022; Published 14 June 2022

Academic Editor: Rahim Khan

Copyright © 2022 Yu Liu et al. This is an open access article distributed under the Creative Commons Attribution License, which
permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

The prevalence of allergic rhinitis has exhibited an upward trend, and diabetes is a common endocrine metabolic disorder.
Treatment of allergic rhinitis complicated with diabetes has been marginally explored. This study aimed to observe the effect of
rupatadine fumarate combined with acupoint application in the treatment of allergic rhinitis complicated with diabetes and its
effect on serum IgE levels. Totally 80 patients with allergic rhinitis complicated with diabetes admitted to our hospital from
December 2019 to December 2020 were recruited and assigned to receive either rupatadine fumarate (control group) or
rupatadine fumarate plus acupoint application (research group). The clinical observation indexes of the two groups of patients
before and after treatment were analyzed, and the clinical efficacy of the two groups was evaluated. Rupatadine fumarate plus
acupoint application was associated with a significantly higher efficacy (23 cases of markedly effective, 14 cases of effective, and 3
cases of ineffective) versus rupatadine fumarate alone (14 cases of markedly effective, 16 cases of effective, and 10 cases of
ineffective) (χ2  4.501, p  0.034). The immunoglobulin E (IgE) and nasal mucosal eosinophils (EOS) levels of the two groups of
patients after treatment decreased significantly, and the research group had lower results (p < 0.05). Patients in the research group
showed significantly lower syndrome scores than those in the control group (p < 0.05). Rupatadine fumarate plus acupoint
application resulted in significantly lower physical sign scores and interleukin-4 (IL-4) levels and higher levels of interferon-
gamma (INF-c) versus rupatadine fumarate alone (p < 0.05). The two groups showed a similar incidence of adverse events
(p > 0.05). Rupatadine fumarate plus acupoint application may offer a viable alternative for the treatment of allergic rhinitis as it
alleviates the clinical symptoms, improves the treatment efficiency, and enhances the anti-allergic effect of the drug, with a high
safety profile.

1. Introduction remains controversial in clinical settings since antihista-

In recent years, the prevalence of allergic rhinitis has
exhibited an upward trend due to environmental factors
such as air pollution. Statistics show that the global incidence
of the disease is 10–20% [1–3]. Diabetes may lead to allergic
rhinitis due to impaired immune function [4]. At present,
clinical treatment for allergic rhinitis is mainly based on
antihistamines or corticosteroids [5]. However, the efficacy
mines and corticosteroids are associated with recurrence and
adverse drug reactions [6].
Recently, traditional Chinese medicine (TCM) treatment
has demonstrated great advantages in clinical medicine
[7, 8]. Acupoint application is a treatment method guided by
the basic theory of TCM, applying Chinese herbal prepa-
rations to the acupoints [9, 10]. Acupoint application
therapy is used to stimulate the meridians, harmonize qi and
2 Computational Intelligence and Neuroscience
blood, improve blood circulation, enhance immune func-
tion, and regulate the dynamic balance of the human body
through acupoint stimulation [11]. TCM classifies allergic
rhinitis into the category of bi-qiu, and acupuncture and
acupoint application are frequently used for early treatment
[12]. This study intends to combine acupoint application
therapy with rupatadine fumarate to enhance the curative
effect of allergic rhinitis and enrich the clinical data for the
treatment of allergic rhinitis.
2. Materials and Methods
2.1. Inclusion Criteria. Patients who met the western med-
icine diagnostic criteria in Guidelines for the Diagnosis and
Treatment of Allergic Rhinitis [13], TCM diagnostic criteria
in Guidelines for the Diagnosis of Common Diseases in TCM
Otorhinolaryngology [14], and diagnostic criteria for dia-
betes, aged >18 years old, with no recent use of anti-allergic
rhinitis drugs two weeks prior to enrollment, who volun-
tarily participated in the study, with good treatment com-
pliance, and with no allergies to the drugs used in this study
were included.
2.2. Exclusion Criteria. Patients with severe systemic dis-
eases, with allergic sinusitis, acute rhinitis, autonomic rhi-
nitis, and other diseases, with allergic asthma, with
communication impairments, cognitive disorders, or
physical disabilities, during pregnancy or lactation, and with
use of peripheral H1 receptor antagonist within 1 week
before enrollment were excluded.
2.3. Screening and Grouping. Between December 2019 and
December 2020, 80 patients with allergic rhinitis admitted to
our hospital were considered eligible and recruited as per the
inclusion and exclusion criteria. According to the treatment
plan of the patients, they were equally assigned to a control
group or a research group. This study is a retrospective
analysis, does not interfere with the patient’s treatment plan,
and is supervised by the ethics committee of Affiliated
Hospital of Nanjing University of Chinese Medicine, No.
A-NJ1138.
2.4. Method. Patients in the control group received 10 mg
rupatadine fumarate tablets (Yangzijiang Pharmaceutical
Group Nanjing Hailing Pharmaceutical Co., Ltd., approval
no. H20130047) daily after meals in the evening. A similar
treatment protocol of rupatadine fumarate was introduced
to the patients in the research group.
Patients in the research group received additional acu-
point application. (1) Drug preparation: Corydalis, white
mustard seeds, asarum, and raw kansui were ground into
powder and mixed well at a ratio of 1 : 1 : 0.5 : 0.5, followed by
the addition of ginger juice to make a herbal paste, and
borneol and a small amount of vaseline were added to
prepare a 1 cm × 1 cm × 0.5 cm medicinal pie. (2) The acu-
point application was performed on the following acupoints
of Xinshu (bilateral), Feishu (bilateral), Geshu (bilateral),
Shenshu (bilateral), Pishu (bilateral), Guanyuan, and Dazhui
using the prepared medicinal cakes. (3) Application method:
the medicinal cakes were applied to the corresponding
acupoints, fixed with a 5 cm × 5 cm desensitizing tape and
removed after 8 hours. The skin of the application site should
be protected from water for 24 hours. The acupoint appli-
cation was performed once per week, with four weeks as a
course of treatment. (4) Precautions: the patients were ad-
vised against scratching the skin in the case of redness and
swelling or small red blisters on the skin of the application
site, and 75% alcohol was used for local disinfection.
All patients received nasal irrigation with normal saline
thrice, and the duration of treatment was 1 month.
2.5. Observation Indicators
2.5.1. Baseline Patient Profile. The baseline patient profile of
the patients such as age, gender, course of disease, BMI,
smoking, drinking, and education level was recorded.
2.5.2. Clinical Efficacy. With reference to Allergic Rhinitis
Diagnosis and Efficacy Evaluation Criteria [15], the clinical
efficacy of patients after treatment was evaluated. Effica-
cy � (total scores before treatment − total scores after
treatment)/total scores before treatment × 100%. Curative
effect index ≥66% is considered markedly effective, 26% ≤
curative effect index ≤65% is effective, and curative effect
index ≤25% is ineffective. The total treatment
efficacy � (effective + markedly effective)/total × 100%.
2.5.3. Serum IgE Level. 5 ml of fasting venous blood was
collected from the patient before and after treatment. After
anticoagulation and centrifugation, the serum IgE level of
the patient was determined using the enzyme-linked im-
munosorbent assay.
2.5.4. Nasal Mucosal Eosinophils (EOS). A cotton swab was
used to swab the patient’s turbinate forward and backward
2–3 times, and the exfoliated cells of the nasal mucosa were
smeared on the glass slide. The collected exfoliated cells of
nasal mucosa were prepared for observation by paraffin
embedding, dewaxing, hematoxylin-eosin staining, dehy-
dration, xylene transparent, and neutral gum sealing, and the
morphology of eosinophils was observed under light mi-
croscope. The EOS counts of 10 or more consecutive visual
fields were carried out under high power field (40 × 10 x),
and the average was taken to score.
2.5.5. Syndrome Scores. ① Sneezing: no more than 3 con-
secutive sneezes are recorded as 0 points, 3–9 consecutive
sneezes are recorded as 1 point, 10–14 consecutive sneezes
are recorded as 2 points, and 15 consecutive sneezes or more
are recorded as 3 points. ② Running nose: 0 points indicate
that the number of times to wipe the nose is less than 2 times
daily; 1 point indicates that the number of times to wipe the
nose is 2–4 daily; 2 points indicate that the number of times
to wipe the nose is 5–9 daily; and 3 points indicate that the
Computational Intelligence and Neuroscience 3

Table 1: Comparison of general information of the two groups of patients (n � 40).

Control Research t/χ2 P value
Age (year) 30.53 ± 6.17 31.09 ± 7.11 0.376 0.708
Course of disease (year) 4.23 ± 1.21 4.16 ± 1.17 0.263 0.793
Gender 0.201 0.654
Male 22 (55) 20 (50)
Female 18 (45) 20 (50)
BMI (kg/m2) 24.16 ± 2.34 24.08 ± 2.27 0.155 0.877
History of smoking 0.457 0.499
Yes 24 (60) 21 (52.5)
No 16 (40) 19 (47.5)
History of drinking 0.800 0.371
Yes 18 (45) 22 (55)
No 22 (55) 18 (45)
Educational background 0.200 0.655
Middle school 11 (27.5) 10 (25)
Middle school to high school 8 (20) 11 (27.5)
High school or above 21 (52.5) 19 (47.5)

number of times to wipe the nose is 10 or more daily. ③ 100

92.5%
Nasal Congestion. 0 points: there is no need to breathe 90
through the mouth; 1 point: the patient occasionally 80 75%
breathes through the mouth; 2 points: the patient frequently 70
breathes through the mouth; and 3 points: the patient cannot 57.5%
60
breathe through the nose completely. ④ Itchy nose: 0 points
50
indicate no itching, 1 point indicates occasional itching, 2 40%
points indicate tolerable persistent itching, and 3 points 40 35% 35%
indicate unbearable nasal itching. 30 25%
20
10 7.5%
2.5.6. Physical Signs Scores. 1 point: there is mild swelling of 0
the lower nose; the middle turbinate and nasal septum are Inefficiency Efficiency Apparent Total effective
still visible; 2 points: the nasal septum is close to the inferior efficiency rate
turbinate, and there are small gaps between the inferior
turbinate and nasal septum; 3 points: the inferior turbinate is Control group
close to the nasal septum and the base of the nose, and no Research group
middle turbinate or middle turbinate mucosal polypoid Figure 1: Comparison of the clinical efficacy of the two groups of
changes can be seen. patients (n � 40,%).

2.5.7. Serum Inflammatory Substances. Enzyme-linked 3. Results

immunosorbent assay was used to determine the serum
interleukin-4 (IL-4) and interferon-c (IFN-c) levels before 3.1. Baseline Patient Profile. The general data of the two
and after treatment. groups of patients were not statistically different (P > 0.05)
(Table 1).

2.5.8. Incidence of Adverse Reactions. The adverse reactions

during the treatment of the two groups of patients were
recorded.
2.6. Statistical Analysis. GraphPad Prism 7 (GraphPad
Software, San Diego, USA) was used to plot the graphics, and
SPSS23.0 software was used for data analyses. The counting
data are expressed as [n(%)] and analyzed using the chi-
square test, and measurement data are expressed as
(mean ± SD) and analyzed using students’ t-test. Differences
were considered statistically significant at p < 0.05.
3.2. Clinical Efficacy. In the control group, 14 cases were
markedly effective, 16 cases were effective, and 10 cases were
ineffective. In the research group, 23 cases were markedly
effective, 14 cases were effective, and 3 cases were ineffective.
Rupatadine fumarate plus acupoint application was asso-
ciated with a significantly higher efficacy versus rupatadine
fumarate alone (χ 2 � 4.501, p � 0.034). (Figure 1).
3.3. Serum IgE Levels. The IgE levels of the two groups of
patients after treatment significantly decreased, and the
research group had lower results (p < 0.05). (Figure 2).
4 Computational Intelligence and Neuroscience
250
200
150
IU (ml)
*
100
50
0
Before treatment After treatment
Control group
Research group
Figure 2: Comparison of the IgE levels of the two groups of
patients. Note. The abscissa indicates before and after treatment,
and the ordinate indicates the level, IU/ml; the IgE levels of the
control group before and after treatment were (204.63 ± 32.15) and
(97.86 ± 14.15), respectively; the IgE levels of the research group
before and after treatment were (205.55 ± 33.21) and
(90.37 ± 13.47), respectively; ∗ indicates that the IgE levels of the two
groups of patients after treatment were significantly different
(t � 2.425, p � 0.018).
3.4. EOS Content. After treatment, the EOS content of the
two groups of patients decreased, and the EOS content of the
research group was significantly lower than that of the
control group (p < 0.05, Figure 3).
3.5. Syndrome Scores. The research group had significantly
lower syndrome scores than the control group (p < 0.05).
(Table 2).
3.6. Vital Sign Scores. The physical sign scores of the two
groups of patients were reduced after treatment, and the
research group showed significantly lower results (p < 0.05)
(Table 3).
3.7. Serum Inflammatory Factor Levels. Rupatadine fumarate
plus acupoint application resulted in significantly lower IL-4
levels and higher levels of INF-c versus rupatadine fumarate
alone (p < 0.05). (Figures 4 and 5).
3.8. Incidence of Adverse Reactions. The two groups showed a
similar incidence of adverse events (p > 0.05).
4. Discussion
Allergic rhinitis is an IgE-mediated inflammatory disease of
the nasal mucosa, which is caused by exposure to allergens
[16]. Thus, anti-allergy is an essential part of the treatment of
the disease. It is documented that rupatadine fumarate
tablets are a potent anti-allergic drug. Clinical research
found that rupatadine fumarate relieved the clinical
symptoms and signs of allergic rhinitis and reduces the
infiltration of eosinophils in the nasal mucosa. Moreover, its
combination with acupoint application can further improve
20
Number/field of vision
15
10
*
5
0
Before treatment After treatment
Control group
Research group
Figure 3: Comparison of the EOS content of the two groups of
patients.
curative effect of allergic rhinitis and mitigate the symptoms,
suggesting that rupatadine fumarate plus acupoint appli-
cation shows a desirable effect in the treatment of allergic
rhinitis. Accordingly, this study was conducted to explore
the application effect of rupatadine fumarate plus acupoint
application in allergic rhinitis complicated diabetes patients
admitted to our hospital.
Western medicine recognizes that the onset of allergic
rhinitis is related to the patient’s physique and allergens [17].
After the allergen enters the nasal cavity for the second time,
it binds to IgE on eosinophils and releases a large number of
mediators such as leukotrienes and histamine to induce
tissue edema and eosinophil infiltration. In this regard, the
prerequisite for clinical treatment of allergic rhinitis lies in
the identification of the allergen [18]. Relevant experimental
studies have shown that the anti-tissue activity of rupatadine
fumarate is significantly better than that of commonly used
drugs such as loratadine and cetirizine [19]. The drug can
effectively inhibit the activity of eosinophils, mast cells, and
neutrophils and suppress the release of cytokines, emanating
outstanding effects on the treatment of allergic rhinitis and
urticaria. In the present study, patients in the control group
were treated with rupatadine fumarate alone for one month
and its was found that their signs and symptoms were al-
leviated, and EOS, IgE levels, and inflammatory cytokines
were all ameliorated, suggesting the outstanding clinical
value of rupatadine fumarate in the treatment of allergic
rhinitis, and the results are consistent with the previous
studies.
Chinese medicine believes that the contributory factors
for allergic rhinitis include chill and wind, insufficient qi,
and evil invasion, leading to deficiency of the spleen, kid-
neys, and lungs. Acupuncture, acupoint application, and
Chinese medicine decoctions are key treatment methods to
consolidate the function of viscera and the body’s immunity,
thereby mitigating clinical symptoms [20]. In the present
study, patients in the research group were treated with
rupatadine fumarate plus acupoint application using me-
dicinal cakes with corydalis yanhusuo, white mustard seeds,
asarum, and kansui root as ingredients for anti-allergic
Computational Intelligence and Neuroscience 5

Table 2: Comparison of the syndrome scores of the two groups of patients.

Control (n � 40) Research (n � 40)
Before treatment After treatment Before treatment After treatment
Sneeze 2.38 ± 0.61 1.60 ± 0.59 2.41 ± 0.58 1.29 ± 0.44
tcontrol-research/Pcontrol-research 2.664/0.0094
Running nose 2.40 ± 0.54 1.44 ± 0.54 2.39 ± 0.52 1.09 ± 0.33
tcontrol-research/Pcontrol-research 3.498/0.0008
Nasal obstruction 2.09 ± 0.61 1.56 ± 0.35 2.13 ± 0.58 1.26 ± 0.43
tcontrol-research/Pcontrol-research 3.422/0.001
Rhinocnesmus 1.88 ± 0.35 1.55 ± 0.34 1.89 ± 0.37 1.14 ± 0.56
tcontrol-research/Pcontrol-research 3.907/0.0002
Total score 8.73 ± 1.31 6.18 ± 1.42 8.70 ± 1.27 4.87 ± 1.34
tcontrol-research/Pcontrol-research 4.244/0.0001

140 *
Table 3: Comparison of the physical sign scores of the two groups
of patients. 120

Group n Before treatment After treatment 100

Control 40 2.47 ± 0.55 1.53 ± 0.52
80
ng (L)
Research 40 2.46 ± 0.53 0.91 ± 0.42
t-value 5.866 60
P value <0.001
40

20

150 0
Before treatment After treatment

Research group
100 Control group
pg (ml)

Figure 5: Comparison of serum INF-c levels of two groups of

patients. Note. The abscissa indicates before and after treatment,
and the ordinate indicates the detection level, ng/L; the INF-c levels
50 of the control group before and after treatment were (45.15 ± 10.75)
* and (55.63 ± 10.49), respectively; the INF-c levels of the research
group before and after treatment were (47.13 ± 11.02) and
(68.27 ± 16.02), respectively; ∗ indicates that the INF-c levels of the
0 two groups of patients after treatment were significantly different
Before After Before After (t � 4.175, p < 0.001).
treatment treatment treatment treatment

Control group
Research group
Figure 4: Comparison of the serum IL-4 levels of the two groups of
patients. Note. The abscissa indicates before and after treatment,
and the ordinate indicates the detection level, pg/ml; the IL-4 levels
of the control group before and after treatment were (78.93 ± 16.47)
and (17.05 ± 4.21), respectively; the IL-4 levels of the research group
before and after treatment were (79.06 ± 16.69) and (12.11 ± 3.35),
respectively; ∗ indicates that the IL-4 levels of the two groups of
patients after treatment were significantly different (t � 5.807,
p < 0.001).
treatment. Corydalis yanhusuo can promote blood circu-
lation and invigorate lung q, white mustard seeds warm the
lungs and eliminate phlegm, asarum can dispel the heat, and
kansui root can eliminate phlegm and induce diuresis to
alleviate edema [21]. The combination of the above herbs for
acupoint application can warm yang, promote qi, dispel
wind and chill, and clarify the nose and orifices. The results
of the present study indicated that the acupoint application
plus rupatadine fumarate can further enhance the thera-
peutic effect of allergic rhinitis and reduce the level of IgE,
IL-4, and EOS activity. In addition, INF-c inhibits the
synthesis of IgE from B cells, and the patient’s INF-c level
after treatment was significantly increased, indicating that
acupoint application could effectively regulate the immune
balance of patients with allergic rhinitis, reduce inflam-
mation responses, and relieve clinical symptoms. The EOS
content of nasal secretions in the research group of the
patients after treatment was reduced, which is in line with
6 Computational Intelligence and Neuroscience
the research results by Eocak et al. The limitation of this
study lies in the absence of the exploration of the drug
mechanism. More prospective randomized controlled
studies are required for in-depth exploration of the possible
mechanism to provide more evidence-based references for
disease treatment.
5. Conclusion
Rupatadine fumarate plus acupoint application may offer a
viable treatment alternative for allergic rhinitis complicated
with diabetes as it alleviates the clinical symptoms, improves
treatment efficiency, and enhances the anti-allergic effect of
the drug, with a high safety profile. However, this study is a
retrospective study, with a small sample size and short
follow-up. Thus, further studies are required to evaluate the
long-term efficacy of rupatadine fumarate plus acupoint
application for the treatment of allergic rhinitis complicated
with diabetes.
Data Availability
The data used to support the findings of this study are
available from the corresponding author upon request.
Conflicts of Interest
The authors declare that they have no conflicts of interest.
Authors’ Contributions
All authors contributed equally.
Acknowledgments
This study was supported by the National Natural Science
Foundation of China (81674035 and 81704126), a Project
Funded by the Priority Academic Program Development of
Jiangsu Higher Education Institutions (PAPD) Open
Projects of the Discipline of Chinese Medicine of Nanjing
University of Chinese Medicine Supported by the Subject of
Academic priority discipline of Jiangsu Higher Education
Institutions (ZYX03KF028), 2020 Nanjing Health Science
and Technology development special fund project
(YKK20159), and Top talent project of “six one project” for
High Level Health Talents of Jiangsu Province of China
(LGY2020022).
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