Eosinophilia-myalgia syndrome 63050 221757825 2008-06-25T23:31:05Z DOI bot 6652755 Citation maintenance. Removed redundant parameters. You can [[WP:DOI|use this bot]] yourself! Please [[User:DOI_bot/bugs|report any bugs]]. {{DiseaseDisorder infobox | Name = Eosinophilia-myalgia syndrome | ICD10 = | ICD9 = {{ICD9|710.5}} | Image = | Caption = | ICDO = | OMIM = | DiseasesDB = 32044 | MedlinePlus = | eMedicineSubj = derm | eMedicineTopic = 891 | }} '''Eosinophilia-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.<ref name="Bolton_1991">{{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 }}</ref><ref name="pmid2005606">{{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 }}</ref> Similar to regular [[eosinophilia]], it causes an increase in [[eosinophil granulocyte]]s in the patient's blood.<ref name="pmid8895183">{{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 = }}</ref><ref name="pmid9213377">{{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 = }}</ref> == History == ''See also [[tryptophan#Tryptophan supplements and EMS| tryptophan and EMS]].''<br /> 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 the [[Centers for Disease Control and Prevention]] in November of 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 studies<ref name="pmid2355442">{{cite 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 }}</ref><ref name="pmid8496862">{{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 = }}</ref><ref name="pmid8895184">{{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 = }}</ref> traced the cause to consumption of L-tryptophan from a single Japanese manufacturer, [[Showa Denko|Showa Denko]].<ref name="urlFDA/CFSAN - Information Paper on L-tryptophan and 5-hydroxy-L-tryptophan">{{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}}</ref> 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 [[genetic engineering|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 used [[charcoal]] 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.<ref name="pmid2270484">{{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 }}</ref><ref name="isbn0-444-81283-0">{{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 }}</ref><ref name="urlUpdate: Analysis of L-Tryptophan for the Etiology of Eosinophilia-Myalgia Syndrome">{{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}}</ref> 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). For more information, please refer to the link below entitled ''5-HTP Contaminants Comments''. ==Recent developments== An alternative explanation for tryptophan associated EMS has recently been proposed.<ref name="pmid16307217">{{cite journal | author = Smith MJ, Garrett RH | title = A heretofore undisclosed crux of eosinophilia-myalgia syndrome: compromised histamine degradation | journal = Inflamm. Res. | volume = 54 | issue = 11 | pages = 435–50 | year = 2005 | pmid = 16307217 | doi = 10.1007/s00011-005-1380-7 }}</ref> Consumption of large doses of tryptophan leads to production of [[metabolites]], some of which may interfere with normal [[histamine]] degradation. Furthermore excessive histamine activity has been linked blood [[eosinophilia]] and [[myalgia]]. ==References== {{Reflist|2}} ==See also== * [[Toxic oil syndrome]] *[[Cattle Health Initiative]] (British) ==External links== * {{MeshName|Eosinophilia-Myalgia+Syndrome}} * [http://www.nemsn.org/ National Eosinophilia Myalgia Syndrome Network] * [http://www.musc.edu/rheumatology/FAQs/FAQ-Eosin-Myal.html What is eosinophilia-myalgia syndrome?] * [http://www.eosinophilia-myalgia.net/ Eosinophilia-Myalgia Syndrome: Information & Support] * [http://www.erowid.org/smarts/tryptophan/tryptophan_info3.shtml/ 5-HTP Contaminants Comments] [[Category:Rheumatology]] [[Category:Toxicology]] [[Category:Amino acids]]