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Dig Liver Dis. 2014 Mar;46(3):264-9. doi: 10.1016/j.dld.2013.10.020. Epub 2013 Dec 5.

Herbal hepatotoxicity: analysis of cases with initially reported positive re-exposure tests.

Author information

1
Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University, Frankfurt/Main, Germany. Electronic address: rolf.teschke@gmx.de.
2
Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University, Frankfurt/Main, Germany.
3
Department of Internal Medicine II, Division of Gastroenterology, Hepatology and Infectious Diseases, Friedrich Schiller University Jena, Germany.
4
Department of Medicine I, University Medical Center Hamburg Eppendorf, Germany.
5
Institute of Industrial, Environmental and Social Medicine, Medical Faculty, Goethe University Frankfurt/Main, Germany.

Abstract

BACKGROUND:

Positive re-exposure tests are diagnostic hallmarks for hepatotoxicity.

OBJECTIVE:

To test validity of positive re-exposures in herb induced liver injury.

METHODS:

We searched Medline database for cases of herb induced liver injury with positive re-exposures and analysed 34 cases for positive re-exposure test criteria of baseline alanine aminotransferase< 5N before re-exposure, and re-exposure alanine aminotransferase ≥ 2× baseline alanine aminotransferase. Re-exposure test was negative, if baseline alanine aminotransferase< 5N combined with re-exposure alanine aminotransferase< 2× baseline alanine aminotransferase, or if baseline alanine aminotransferase≥ 5N regardless of the re-exposure alanine aminotransferase including no available re-exposure alanine aminotransferase result.

RESULTS:

In 21/34 cases (61.8%), criteria for a positive re-exposure were fulfilled, with negative tests in 6/34 cases (17.6%) or uninterpretable ones in 7/34 cases (20.6%). Confirmed positive re-exposure tests established potential of herb induced liver injury for Aloe, Chaparral, Chinese herbal mixtures, Chinese Jin Bu Huan, Chinese Syo Saiko To, Germander, Greater Celandine, Green tea, Kava, Mistletoe, Polygonum multiflorum, and Senna, with up to 4 case reports per herb.

CONCLUSIONS:

Among 34 cases of herb-induced liver injury with initially reported positive re-exposure tests, 61.8% of the cases actually fulfilled established test criteria and provided firm diagnoses of herb induced liver injury by various herbs.

KEYWORDS:

Herb induced liver injury; Herbal hepatotoxicity; Herbs; Positive re-exposure tests

PMID:
24315480
DOI:
10.1016/j.dld.2013.10.020
[Indexed for MEDLINE]

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