TY  - JOUR
A1  - Teschke, Rolf
A1  - Eickhoff, Axel Stefan
A1  - Wolff, Albrecht Titus
A1  - Frenzel, Christian
A1  - Schulze, Johannes B.
T1  - Herbal hepatotoxicity and WHO global introspection method
T2  - Annals of Hepatology
N2  - Herbal hepatotoxicity is a rare but highly disputed disease because numerous confounding variables may complicate accurate causality assessment. Case evaluation is even more difficult when the WHO global introspection method (WHO method) is applied as diagnostic algorithm. This method lacks liver specificity, hepatotoxicity validation, and quantitative items, basic qualifications required for a sound evaluation of hepatotoxicity cases. Consequently, there are no data available for reliability, sensitivity, specificity, positive and negative predictive value. Its scope is also limited by the fact that it cannot discriminate between a positive and a negative causality attribution, thereby stimulating case overdiagnosing and overreporting. The WHO method ignores uncertainties regarding daily dose, temporal association, start, duration, and end of herbal use, time to onset of the adverse reaction, and course of liver values after herb discontinuation. Insufficiently considered or ignored are comedications, preexisting liver diseases, alternative explanations upon clinical assessment, and exclusion of infections by hepatitis A-C, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella zoster virus (VZV). We clearly prefer as alternative the scale of CIOMS (Council for International Organizations of Medical Sciences) which is structured, quantitative, liver specific, and validated for hepatotoxicity. In conclusion, causality of herbal hepatotoxicity is best assessed by the liver specific CIOMS scale validated for hepatotoxicity rather than the obsolete WHO method that is liver unspecific and not validated for hepatotoxicity. CIOMS based assessments will ensure the correct diagnosis and exclude alternative diagnosis that may require other specific therapies.
KW  - Herb induced liver injury
KW  - CIOMS
KW  - Kava
KW  - Pelargonium sidoides
KW  - Herbalife products
Y1  - 2019
UR  - http://publikationen.ub.uni-frankfurt.de/frontdoor/index/index/docId/76897
UR  - https://nbn-resolving.org/urn:nbn:de:hebis:30:3-768975
SN  - 1665-2681
VL  - 12
IS  - 1
SP  - 11
EP  - 21
PB  - Mexican Association of Hepatology
CY  - México
ER  -