Autohemotherapy combined with other external treatments of Traditional Chinese Medicine for chronic urticaria: a systematic review and meta-analysis

Background Chronic urticaria (CU) is a refractory, recurrent skin disease that adversely affects patients’ quality of life, mental health. Autohemotherapy (AHT) and various external treatments of Traditional Chinese Medicine (TCM) are reported to be effective in improving CU with few side effects. This study aims to evaluate the efficacy and safety of AHT combined with various TCM external treatments for CU. Methods This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. 11 Chinese and English databases were searched from database inception to August 10, 2025, for randomized controlled trials (RCTs) on AHT combined with other TCM external treatments for CU. Two researchers independently completed literature screening and data extraction. Study quality was evaluated using the Cochrane Risk of Bias Tool 2.0 (RoB 2.0). Meta-analysis was performed using STATA 18.0. Results A total of 20 studies involving 1,461 participants were included. The intervention group received AHT combined with other TCM external treatments, and the control group received Western medicine. The overall response rate was significantly better in the intervention group (RR: 1.17; 95% Confidence Interval, CI: 1.10–1.24; p < 0.001). Compared to the control group, the intervention group also showed significant improvements in recurrence rate (RR: 0.31; 95% CI: 0.23–0.42; p < 0.001), serum IgE level (SMD: −1.33; 95% CI: −1.76 to −0.91; p < 0.001), pruritus severity (SMD: −1.36; 95% CI: −2.17 to −0.54; p < 0.001), and wheal duration (SMD: −3.05; 95% CI: −6.05 to −0.06; p < 0.005). However, the results for pruritus severity and wheal duration were not robust and showed significant publication bias; therefore, their reliability is questionable. Conclusion Autohemotherapy combined with some other TCM external treatments can improve clinical efficacy and reduce recurrence rates. However, due to concerns regarding unclear randomization and blinding, diverse outcome measures, methodological limitations, and high clinical heterogeneity among the included studies, more rigorous prospective studies are needed to conclusively evaluate its efficacy and safety. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/ , CRD420261281760.