Eosinophilia-myalgia syndrome: results of national surveillance

Article Abstract:

Eosinophilia-myalgia syndrome (EMS) was first recognized in October 1989. Since that time, 1,531 individuals are known to have suffered from the disorder, and 27 have died. The condition was rapidly observed to be associated with the use of L-tryptophan as a dietary supplement, and the removal of such products from the market resulted in a dramatic reduction in new cases. A study of the distribution and characteristics of EMS patients revealed that individuals in western states were more affected, and there was a predominance of non-Hispanic white females among the patients. These features may be accounted for by the distribution in the use of dietary supplements. Dietary supplements are more popular in the western states than elsewhere in the US. Furthermore, non-Hispanic white women account for 80 percent of the use of dietary supplements, which include vitamins, minerals, amino acids, and other nutrients. L-tryptophan has been recommended for insomnia, depression, and premenstrual syndrome. While men are obviously unlikely to take supplements for premenstrual syndrome, it is also true that men are one third less likely to take dietary supplements for insomnia and depression than women. It cannot be ruled out, however, that these women may also have some constitutional predisposition to EMS. Curiously, the features of eosinophilia-myalgia syndrome are similar to those of the toxic oil syndrome, which occurred in Spain in 1981 and affected 20,000 people and caused 330 deaths. The use of L-tryptophan as a dietary supplement preceded the outbreak of EMS by several years, and, indeed, many EMS patients had used tryptophan for years. Consequently, it seems likely that contaminants in commercial tryptophan products, rather than tryptophan itself, are the culprit. The substance responsible for eosinophilia-myalgia syndrome has not been conclusively identified. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Physiological aspects, Demographic aspects, Eosinophil disorders

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Interim guidance on the eosinophilia-myalgia syndrome

Article Abstract:

A new syndrome consisting of eosinophilia, the presence of an unusual number of eosinophils (a type of white blood cell), and myalgia, tenderness or pain in the muscles, reached epidemic proportions in 1989. The eosinophilia-myalgia syndrome is associated with the ingestion of products containing the amino acid L-tryptophan. Symptoms develop over several weeks and commonly include intense, disabling muscle pain and fatigue, and to a lesser extent, joint pain, difficulty breathing, and cough. The physical examination may show skin rash, liver enlargement (hepatomegaly), fluid accumulation in the extremities, or heart disorders. The most striking laboratory findings of the syndrome include eosinophilia, bone marrow abnormalities, and accumulation of inflammatory cells in the muscle. Symptoms of the disease often resolve once L-tryptophan-containing products cease to be consumed, but may persist in some patients, who go on to develop complications such as skin thickening and nerve disease. The relation between ingestion of L-tryptophan products and development of the syndrome is not clear. The Centers for Disease Control established three criteria for diagnosing eosinophilia-myalgia syndrome, including the presence of eosinophilia and myalgia and exclusion of other disorders that may cause those two disorders. Treatment of this syndrome includes cessation of L-tryptophan products, the use of glucocorticoids against inflammation, and nonsteroidal anti-inflammatory drugs and analgesic agents for muscle pain. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Myalgia, Eosinophilia, Syndromes, editorial

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Eosinophilia-myalgia syndrome in L-tryptophan-exposed patients

Article Abstract:

Of 418 patients of a South Carolina psychiatrist who used L-tryptophan in 1989, 47 were diagnosed with eosinophilia-myalgia syndrome according to the Centers for Disease Control (CDC) case definition. An additional 68 who had fewer symptoms were diagnosed as possible cases. Of the 47 confirmed cases, 45 had used the same brand of L-tryptophan, which was traced to the Japanese manufacturer Showa Denko KK. Thirty-six of the possible cases had also used this brand. Of the 157 people who used this brand, 45 were diagnosed with the syndrome and 36 were considered possible cases. The higher the dose taken, the greater the risk of getting the disease. Since many patients using L-tryptophan did not meet the CDC criteria for the disease but nevertheless had several of the symptoms, relying on the CDC criteria may cause physicians to miss many cases.

South Carolina

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