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Daniel Clauw, MD; David Nashel, MD; Paul Katz, MD
JAMA. 1990;264(8):970-971. doi:10.1001/jama.1990.03450080055019.
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In Reply.—  We appreciate the comments of Dr Leadbetter, Mr Birdsall, and Dr Eidson.Dr Leadbetter's comments about the serotonin syndrome are pertinent. However, as he notes, the prominent manifestations of eosinophilia-myalgia syndrome are different from those of serotonin syndrome.We concur with Mr Birdsall that there are a number of host factors, including possible derangements in the hypothalamic-pituitary axis, that might render an individual more susceptible to the development of eosinophilia-myalgia syndrome.1Dr Eidson cites recent epidemiologic evidence that suggests that the outbreak of eosinophilia-myalgia syndrome is due to a contaminant of tryptophan rather than the tryptophan itself. We agree that a contaminant may be responsible for the development of eosinophilia-myalgia syndrome and clearly stated this in our article. However, we continue to believe that abnormal tryptophan metabolism may play a role in this disease, as has been confirmed by the recent work of Silver et al.1


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