Immunological aspects of halothane hepatitis. Possible relevance of biotransformation

The hypothesis that "halothane hepatitis" is related to hypersensitivity to the agent is widely accepted. The hypothesis is based, in part, on reports ostensibly demonstrating cell mediated immunity to halothane in such patients. These reports, however, are open to criticism and have not been confirmed. Halothane is unlikely to be capable of antigenicity in its own right, although reactive metabolites may be involved. We have further investigated cell mediated immunity in patient with alleged halothane hepatitis. Human serum albumin and liver specific protein were chemically trifluoroacetylated and these complexes were used as potential antigens in lymphocyte transformation and leucocyte migration inhibition tests. Using these in vitro indices, cell mediated immunity was not demonstrated in any of the patients studied. It is possible that other metabolites and/or carrier molecules may be involved, and that patients predisposed to autoimmune disease may be particularly at risk.