Tryptophan-Reply

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