title: Herbal hepatotoxicity: analysis of cases with initially reported positive re-exposure tests.
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.
authors: 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.
authors: Rolf
authors: R
authors: Teschke
authors: 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.
authors: Alexander
authors: A
authors: Genthner
authors: Department of Internal Medicine II, Division of Gastroenterology, Hepatology and Infectious Diseases, Friedrich Schiller University Jena, Germany.
authors: Albrecht
authors: A
authors: Wolff
authors: Department of Medicine I, University Medical Center Hamburg Eppendorf, Germany.
authors: Christian
authors: C
authors: Frenzel
authors: Institute of Industrial, Environmental and Social Medicine, Medical Faculty, Goethe University Frankfurt/Main, Germany.
authors: Johannes
authors: J
authors: Schulze
authors: 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.
authors: Axel
authors: A
authors: Eickhoff
mesh_terms: D000410:Alanine Transaminase / Q000097:blood; D000504:Aloe / Q000009:adverse effects; D029972:Bupleurum / Q000009:adverse effects; D028241:Camellia sinensis / Q000009:adverse effects; D028281:Chelidonium / Q000009:adverse effects; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis* / Q000201:enzymology / Q000209:etiology; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D006801:Humans; D020901:Kava / Q000009:adverse effects; D008297:Male; D014784:Mistletoe / Q000009:adverse effects; D010946:Plants, Medicinal / Q000009:adverse effects*; D028502:Polygonum / Q000009:adverse effects; D015203:Reproducibility of Results; D029846:Senna Plant / Q000009:adverse effects; D031367:Teucrium / Q000009:adverse effects
chemical_list: D004365:Drugs, Chinese Herbal; C086355:jin bu huan; D000410:Alanine Transaminase
keywords: Herb induced liver injury; Herbal hepatotoxicity; Herbs; Positive re-exposure tests