Hepatic damage after exposure to halothane in medical personnel

Two surgeons, in whom liver damage developed after occupational exposure to sub-anaesthetic doses of halothane, were found to have a circulating antibody which reacted specifically with halothane-altered hepatocyte membrane components. This antibody has been found previously only in those patients in whom severe hepatic necrosis developed after exposure to halothane and in no other form of liver injury. It may provide a specific diagnostic marker in patients in whom there are other possible causes of liver damage and could, therefore, remove the need for a challenge exposure and its attendant risks. Although massive hepatocellular necrosis after exposure to halothane is rare (Strunin, 1977), up to 20 % of patients have evidence of mild hepatic damage (Trowell, Peto and Cramp ton-Smith, 1975; Wright et al., 1975). There have been a few reports of liver damage developing in medical and paramedical personnel after exposure to sub-anaesthetic doses of the drug (Belfrage, Ahlgren and Axelson, 1966; Klatskin and Kimberg, 1969; Johnston and Mendelsohn, 1971; Lund, Skulberg and Helle, 1974). The evidence for the association is circumstantial, based on detection of abnormal liver function tests after exposure and exclusion of other causes. In recent studies of the mechanisms of hyper-sensitivity-induced liver damage, we have shown that patients in whom fulminant hepatic failure develops after multiple exposures to halothane may have a circulating antibody which reacts with a specific halothane-related hepatocyte membrane determinant (Vergani et al., 1980). We describe two medical practitioners in whom hepatic damage developed after occupational exposure to halo-thane and in whom the antibody was detected