- Eosinophilia-myalgia syndrome
DiseaseDisorder infobox
Name = Eosinophilia-myalgia syndrome
ICD10 =
ICD9 = ICD9|710.5
Caption =
ICDO =
OMIM =
DiseasesDB = 32044
MedlinePlus =
eMedicineSubj = derm
eMedicineTopic = 891
MeshID = D016603Eosinophilia-myalgia syndrome (EMS) is an incurable and sometimes fatal flu-like neurological condition that is believed to have been caused by ingestion of poorly produced
L-tryptophan supplements.cite journal | author = Bolton P, Lindgren CE, Redmon GL | title = A mystery ailment revealed | journal = American Fitness | volume = 9 | issue = 5 (Sept-Oct) | pages = 34–5 | year = 1991| doi = | issn = | url = http://findarticles.com/p/articles/mi_m0675/is_n5_v9/ai_11245811 | accessdate = 2008-05-04 ] cite journal | author = Lindgren CE, Walker LA, Bolton P | title = L-tryptophan induced eosinophilia-myalgia syndrome | journal = Journal of the Royal Society of Health | volume = 111 | issue = 1 | pages = 29–30 | year = 1991 | pmid = 2005606| doi = 10.1177/146642409111100111 ] Similar to regulareosinophilia , it causes an increase ineosinophil granulocyte s in the patient's blood.cite journal | author = Spitzer WO, Haggerty JL, Berkson L, Davis W, Palmer W, Tamblyn R, Laprise R, Mulder LJ | title = Analysis of Centers for Disease Control and Prevention criteria for the eosinophilia-myalgia syndrome in a geographically defined population | journal = The Journal of rheumatology. Supplement | volume = 46 | issue = | pages = 73–9; discussion 79–80 | year = 1996 | pmid = 8895183 | doi = | issn = ] cite journal | author = Blackburn WD | title = Eosinophilia myalgia syndrome | journal = Semin. Arthritis Rheum. | volume = 26 | issue = 6 | pages = 788–93 | year = 1997 | pmid = 9213377 | doi = | issn = ]History
"See also tryptophan and EMS."
Eosinophilia-myalgia syndrome was first recognized after the doctors of 3 American women with mysterious symptoms talked together in 1989. However, many people became ill as long as 2-3 years before the illness was reported to theCenters for Disease Control and Prevention in November 1989. Rheumatologists experienced a large surge of new patients with mysterious symptoms during this period. It is possible that as many as 60,000 individuals became ill from using L-tryptophan.Some epidemiologist studiescite journal | author = Slutsker L, Hoesly FC, Miller L, Williams LP, Watson JC, Fleming DW | title = Eosinophilia-myalgia syndrome associated with exposure to tryptophan from a single manufacturer | journal = JAMA | volume = 264 | issue = 2 | pages = 213–7 | year = 1990 | pmid = 2355442| doi = 10.1001/jama.264.2.213 ] cite journal | author = Back EE, Henning KJ, Kallenbach LR, Brix KA, Gunn RA, Melius JM | title = Risk factors for developing eosinophilia myalgia syndrome among L-tryptophan users in New York | journal = J. Rheumatol. | volume = 20 | issue = 4 | pages = 666–72 | year = 1993 | pmid = 8496862 | doi = | issn = ] cite journal | author = Kilbourne EM, Philen RM, Kamb ML, Falk H | title = Tryptophan produced by Showa Denko and epidemic eosinophilia-myalgia syndrome | journal = The Journal of rheumatology. Supplement | volume = 46 | issue = | pages = 81–8; discussion 89–91 | year = 1996 | pmid = 8895184 | doi = | issn = ] traced the cause to consumption of L-tryptophan from a single Japanese manufacturer,
Showa Denko .cite web | url = http://vm.cfsan.fda.gov/~dms/ds-tryp1.html | title = FDA/CFSAN - Information Paper on L-tryptophan and 5-hydroxy-L-tryptophan | author = Center for Food Safety and Applied Nutrition, Office of Nutritional Products, Labeling, and Dietary Supplements | authorlink = | coauthors = | date = 2001-02-01 | format = | work = | publisher = U S. Food and Drug Administration | pages = | language = | archiveurl = | archivedate = | quote = | accessdate = 2008-05-04] The company supplied the majority of L-tryptophan to the United States under various brand names. There was evidence that new batches of L-tryptophan may have been improperly prepared. First, the specific bacterial culture used to synthesise this tryptophan had recently been genetically engineered to greatly increase tryptophan production. The increased concentrations of tryptophan in the fermentor may in turn have led to increased production of trace impurities. Second, shortcuts had been taken in the purification process to reduce costs. For example, a purification step that usedcharcoal absorption to remove impurities had been modified to reduce the amount of charcoal used. It is possible that one or more of these modifications and/or the environment for manufacture allowed new or greater impurities through the purification system. More than 60 different impurities were identified in the L-tryptophan lots which had been associated with cases of EMS.The specific impurity (or impurities) responsible for the toxic effects was never firmly established, however two compounds, EBT (1,1'-ethylidene-bis-L-tryptophan) and MTCA (1-methyl-1,2,3,4-tetrahydro-beta-carboline-3-carboxylic acid), which are close chemical relatives of L-tryptophan were implicated.cite journal | author = Mayeno AN, Lin F, Foote CS, Loegering DA, Ames MM, Hedberg CW, Gleich GJ | title = Characterization of "peak E," a novel amino acid associated with eosinophilia-myalgia syndrome | journal = Science (journal) | volume = 250 | issue = 4988 | pages = 1707–8 | year = 1990 | month = December | pmid = 2270484 | doi = 10.1126/science.2270484 ] cite book | author = Harati Y | editor = de Wolff FA, Vinken PJ, Bruyn GW | series= Handbook of Clinical Neurology | volume= 20 (64) | | title = Intoxications of the nervous system | edition = | language = | publisher = Elsevier Science | location = Amsterdam | year = 1994 | origyear = | pages = pages 249 - 272| quote = | isbn = 0-444-81283-0 | oclc = | doi = | url = | accessdate = | pages = | chapter = Chapter 17: Eosinophilia-myalgia syndrome and its relationship to toxic oil syndrome| chapterurl = http://books.google.com/books?id=Q2VS1kAwATQC&pg=PA262&lpg=PA262&dq=mtca+ems&source=web&ots=YIXhM4pDjs&sig=oI4C3PtHDhckbyQqsj9BCpYbNoY#PPA249,M1 ] cite web | url = http://www.cdc.gov/mmwr/preview/mmwrhtml/00001822.htm | title = Update: Analysis of L-Tryptophan for the Etiology of Eosinophilia-Myalgia Syndrome | author = Centers for Disease Control and Prevention | authorlink = | coauthors = | date = 1990-11-02 | format = | work = Morbidity and Mortality Weekly Report; 39(43):789-790 | publisher = U.S. Department of Health and Human Services | pages = | language = | archiveurl = | archivedate = | quote = | accessdate = 2008-05-04] cite journal | author = Sidransky H, Verney E, Cosgrove JW, Latham PS, Mayeno AN | title = Studies with 1,1'-ethylidenebis(tryptophan), a contaminant associated with L-tryptophan implicated in the eosinophilia-myalgia syndrome | journal = Toxicol. Appl. Pharmacol. | volume = 126 | issue = 1 | pages = 108–13 | year = 1994 | month = May | pmid = 8184420 | doi = 10.1006/taap.1994.1096 | url = | issn = ]
Regardless of the origin of the toxicity, L-tryptophan was banned from sale in the US in 1991; and other countries followed suit. In February 2001, the FDA loosened the restrictions on the marketing of tryptophan (though not on importation).
Alternative theory
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