 |
|
Eosinophilia-Myalgia Syndrome in L-Tryptophan—Exposed Patients
Mary L. Kamb, MD, MPH;
John J. Murphy, MD;
Jeffrey L. Jones, MD, MPH;
J. Christopher Caston, MD;
Kees Nederlof, MD;
Louise F. Horney, MD, MSPH;
Leslie A. Swygert, MD, MPH;
Henry Falk, MD, MPH;
Edwin M. Kilbourne, MD
JAMA. 1992;267(1):77-82.
Abstract
| |
Objectives.
—To study the incidence of eosinophilia-myalgia syndrome, the risk factors associated with the syndrome, and the clinical spectrum of illness associated with L-tryptophan use in an exposed population.
Design.
—Retrospective cohort and nested case-control studies of risk factors for eosinophilia-myalgia syndrome using inpatient and outpatient chart reviews, telephone interviews, and in-person patient interviews. Descriptive study of clinical course of L-tryptophan users.
Setting.
—Office practice of one psychiatrist based in a small city (population 43467) in South Carolina.
Patients.
—Eligible subjects were all patients from the practice who used L-tryptophan during the 1989 study interval. Of these, 418 (87%) were interviewed.
Main Outcome Measures.
—Clinical spectrum of illness associated with L-tryptophan use, including definite and possible cases of eosinophilia-myalgia syndrome.
Results.
—Among the 418 interviewed L-tryptophan users, we identified 47 definite cases (11%) and 68 possible cases (16%) of eosinophilia-myalgia syndrome, most of which involved patients who were using one retail brand of L-tryptophan (brand A). Among the 157 brand A users, we identified 45 definite cases (29%) and 36 possible cases (23%) of eosinophilia-myalgia syndrome, and the risk for the syndrome increased as the brand A dose increased. Fifty percent (19 of 38) of those using more than 4000 mg/day developed definite eosinophilia-myalgia syndrome, and 84% (32 of 38) developed either definite or possible eosinophilia-myalgia syndrome. On multivariate analysis, risk for definite eosinophilia-myalgia syndrome was associated with brand A dose and age of the patient; however, gender, race, and use of other medications were not associated with the syndrome.
Conclusions.
—These results suggest that many people exposed to the agent causing eosinophilia-myalgia syndrome may develop illness, and dose of presumably contaminated L-tryptophan is the single most important predictor of eosinophilia-myalgia syndrome. The broad range of signs and symptoms reported by patients using L-tryptophan illustrates that a strict case definition may identify only about half of those affected.
(JAMA. 1992;267:77-82)
Author Affiliations
From the Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Ga (Drs Kamb, Murphy, Nederlof, Horney, Swygert, Falk, and Kilbourne) and the Disease Control and Epidemiology Division, South Carolina Department of Health and Environmental Control, Columbia (Dr Jones). Dr Caston is in private practice in Spartanburg, SC.
Footnotes
Reprint requests to Centers for Disease Control, 1600 Clifton Road NE, Mail Stop E-02, Atlanta, GA 30333 (Dr Kamb).
 CiteULike  Connotea  Del.icio.us  Digg  Reddit  Technorati  Twitter
What's this?
THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES
|
The Search for New Off-Label Indications for Antidepressant, Antianxiety, Antipsychotic and Anticonvulsant Drugs
Chouinard
Focus 2006;4:528.
FULL TEXT
Rigorous New Approach to Constructing a Gold Standard for Validating New Diagnostic Criteria, as Exemplified by the Eosinophilia-Myalgia Syndrome
Hertzman et al.
Arch Intern Med 2001;161:2301-2306.
ABSTRACT
| FULL TEXT
The Natural History of Eosinophilia-Myalgia Syndrome in a Tryptophan-Exposed Cohort in South Carolina
Sullivan et al.
Arch Intern Med 1996;156:973-979.
ABSTRACT
Reduced Severity of Eosinophilia-Myalgia Syndrome Associated With the Consumption of Vitamin-Containing Supplements Before Illness
Hatch and Goldman
Arch Intern Med 1993;153:2368-2373.
ABSTRACT
Central Nervous System Involvement in the Eosinophilia-Myalgia Syndrome
Lynn et al.
Arch Neurol 1992;49:1082-1085.
ABSTRACT
Survey of Advertising for Nutritional Supplements in Health and Bodybuilding Magazines
Philen et al.
JAMA 1992;268:1008-1011.
ABSTRACT
Effect of Benzodiazepines on Tryptophan Binding to Rat Hepatic Nuclei
Sidransky et al.
Toxicol Pathol 1992;20:350-356.
ABSTRACT
|
