Challenge tests and kampo medicines: case report and review of the literature.
In order to diagnose Kampo medicine-induced liver injury, a challenge test using the suspected medicine is the most reliable method of assessing the relationship between Kampo medication and liver injury. However, such a challenge test may cause severe liver injury. We examined the clinical features and safety of challenge tests conducted by a physician in a case of Kampo medicine-induced liver injury that we encountered as well as in the previous literature (six cases) in Japan. In all cases except two, one-third of the daily dose was given a few times for the challenge test (challenge dose was not described in two cases). The reaction induced by the challenge peaked 1-3 days after challenge. Mild eosinophilia (6%) was observed in two cases. All liver injuries induced by challenge cleared within 2 weeks, and neither severe nor fatal liver injury was observed. In conclusion, a challenge with a small dose of Kampo medicine conducted in our case and in the previous literature induced mild and reversible liver injury. The safety and availability of challenge with a small dose of Kampo medicine should be further examined in a larger population with Kampo medicine-induced liver injury.
Department of Integrated Japanese Oriental Medicine, Faculty of Medicine, Gunma University School of Medicine, Maebashi, Japan. nmantani@showa.gunma-u.ac.jp
Naoki
N
Mantani
Toshiaki
T
Kogure
Jun'ichi
J
Tamura
Yutaka
Y
Shimada
Katsutoshi
K
Terasawa
D056486:Chemical and Drug Induced Liver Injury / Q000453:epidemiology* / Q000209:etiology*; D004365:Drugs, Chinese Herbal / Q000008:administration & dosage / Q000633:toxicity*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008499:Medical Records; D020835:Medicine, Kampo; D008517:Phytotherapy; D010936:Plant Extracts / Q000008:administration & dosage / Q000633:toxicity; D012189:Retrospective Studies; D018675:Toxicity Tests / Q000379:methods / Q000706:statistics & numerical data*
D004365:Drugs, Chinese Herbal; D010936:Plant Extracts