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World J Hepatol. Jul 27, 2013; 5(7): 353-363
Published online Jul 27, 2013. doi: 10.4254/wjh.v5.i7.353
Published online Jul 27, 2013. doi: 10.4254/wjh.v5.i7.353
Herbalife hepatotoxicity: Evaluation of cases with positive reexposure tests
Rolf Teschke, Alexander Schwarzenboeck, Axel Eickhoff, 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, D-63450 Hanau, Germany
Christian Frenzel, Department of Medicine I, University Medical Center Hamburg Eppendorf, D-20246 Hamburg, Germany
Johannes Schulze, Institute of Industrial, Environmental and Social Medicine, Medical Faculty of the Goethe University Frankfurt/Main, D-60590 Frankfurt/Main, Germany
Author contributions: Teschke R and Eickhoff A provided substantial contributions to conception and design; Frenzel C contributed to acquisition of data; Frenzel C, Schulze J and Schwarzenboeck A contributed to analysis and interpretation of data; Teschke R and Eickhoff A contributed to drafting the article; Frenzel C, Schulze J and Schwarzenboeck A contributed to revising it critically for important intellectual content; and Teschke R, Frenzel C, Schulze J, Schwarzenboeck A and Eickhoff A contributed to final approval of the version to be published.
Correspondence to: Rolf Teschke, Professor, Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University of Frankfurt/Main, Leimenstrasse 20, D-63450 Hanau, Germany. rolf.teschke@gmx.de
Telephone: +49-6181-21859 Fax: +49-6181-2964211
Received: January 9, 2013
Revised: June 3, 2013
Accepted: June 19, 2013
Published online: July 27, 2013
Revised: June 3, 2013
Accepted: June 19, 2013
Published online: July 27, 2013
Core Tip
Core tip: Our analysis focuses on published cases of suspected Herbalife hepatotoxicity with positive reexposure tests and high causality gradings. Problems included poorly fulfilled test criteria, numerous confounding variables, and the use of liver unspecific, obsolete causality assessment methods. Submitting the case data to well established criteria for positive reexposure tests, the test was positive in 1/8 cases and negative or uninterpretable in the other cases. Using the liver specific Council for International Organizations of Medical Sciences scale, causality was probable in 1 case, unlikely and excluded in the other cases. Thus, causality levels were much lower than hitherto proposed.