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October 3, 1990, Vol 264, No. 13 >
ARTICLE | October 3, 1990

Eosinophilia-Myalgia Syndrome: Title and subTitle BreakResults of National Surveillance FREE

Leslie A. Swygert, MD; Edmond F. Maes, PhD; Leeann E. Sewell, MPH; Lynn Miller, DVM, MPH; Henry Falk, MD, MPH; Edwin M. Kilbourne, MD
[+] Author Affiliations

Reprint requests to the Hawaii Department of Health, Office of Health Status Monitoring, PO Box 3378, Honolulu, HI 96801-9984 (Dr Swygert).


JAMA. 1990;264(13):1698-1703. doi:10.1001/jama.1990.03450130070029
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References

Eosinophilia-myalgia syndrome, a newly recognized disorder that occurred in epidemic proportions during 1989, is associated with ingestion of manufactured tryptophan. A case is defined by debilitating myalgias and absolute eosinophilia greater than or equal to 1.0 × 109 cells/L. As of July 10,1990, a total of 1531 cases had been reported nationwide, including 27 deaths. The highest rates of reported illness are concentrated in the western states, 68% are non-Hispanic white women aged 35 years and older, and data on associated clinical findings suggest a multisystemic disorder. The most frequent features include arthralgia (73%), rash (60%), cough or dyspnea (59%), peripheral edema (59%), elevated aldolase level (46%), and elevations in the results of liver function tests (43%). Neuropathy or neuritis, resulting in paralysis and death in some patients, was seen in 27%, and chest roentgenogram abnormalities were noted in 21% of those tested. Ninety-one percent reported onset of symptoms during or after May 1989, and 97% reported having taken tryptophan before the onset of symptoms. Since the recall of over-the-counter preparations of tryptophan in November 1989, the number of new cases of this potentially fatal disorder has fallen dramatically.

(JAMA. 1990;264:1698-1703)

REFERENCES

1 +
Centers for Disease Control.  Eosinophilia-myalgia syndrome—New Mexico . MMWR. 1989;;38:765-767.
2 +
Hertzman PA, Blevins WL, Mayer J, Greenfield B, Ting M, Gleich G.  Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan . N Engl J Med. 1990;;322:869-873.
3 +
Centers for Disease Control.  Eosinophilia-myalgia syndrome and L-tryptophan-containing products—New Mexico, Minnesota, Oregon, and New York, 1989 . MMWR. 1989;;38:785-788.
4 +
Kilbourne EM, Swygert LA, Philen RM, et al.  Interim guidance on the eosinophilia-myalgia syndrome . Ann Intern Med. 1990;;112:85-87.
5 +
Centers for Disease Control.  Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan—United States, as of January 9, 1990 . MMWR. 1990;;39:14-15.
6 +
Centers for Disease Control.  Clinical spectrum of eosinophilia-myalgia Syndrome—California . MMWR. 1990;;39:89-91.
7 +
 Projections of the population of states, by age, sex, and race: 1989 to 2010 . In: Current Population Reports . Washington, DC: Bureau of the Census; 1990;. Series P-25, No. (1053) .
8 +
 Population estimates for Puerto Rico and outlying areas: 1980 to 1988 . In: Current Population Reports . Washington, DC: Bureau of the Census; 1989. Series P-25, No. (1049) .
9 +
Centers for Disease Control.  Guidelines for evaluating surveillance systems . MMWR. 1988;; 37( (suppl) ):1-18.
10 +
Eidson M, Philen RM, Sewell CM, Voorhees R, Kilbourne EM.  L-tryptophan and eosinophilia-myalgia syndrome in New Mexico . Lancet. 1990;; 335:645-648.
11 +
Moss AJ, Levy AS, Kim I, Park YK.  Use of vitamin and mineral supplements in the United States: current users, types of products, and nutrients . In: Advance Data From Vital and Health Statistics: No 174 . Hyattsville, Md: National Center for Health Statistics; 1989;. Dept of Health and Human Services publication PHS 89-1250.
12 +
Boman B.  L-tryptophan: a rational antidepressant and a natural hypnotic? Aust N Z J Psychiatry. 1988;;22:83-97.
13 +
Wurtman JJ.  Carbohydrate craving, mood changes, and obesity . J Clin Psychiatry. 1988;; 49( (suppl) ):37-39.
14 +
Division of Epidemiology and Prevention Research.  Annual data: 1988 . In: Data From the Drug Abuse Warning Network . Rockville, Md: National Institute on Drug Abuse; 1989;; series 1( (8) ):35. Dept of Health and Human Services publication ADM 89-1634.
15 +
Weissman MM, Leaf PJ, Tischler GL, et al.  Affective disorders in five United States communities . Psychol Med. 1988;;18:141-153.
16 +
Carlson GA, Kashani JH.  Phenomenology of major depression from childhood through adulthood: analysis of three studies . Am J Psychiatry. 1988;;145:1222-1225.
17 +
Barrett JE, Barrett JA, Oxman TE, Gerber PD.  The prevalence of psychiatric disorders in a primary care practice . Arch Gen Psychiatry. 1988;;45:1100-1106.
18 +
Yonker RA, Panush RS.  Idiopathic eosinophilic myositis with preexisting fibromyalgia . J Rheumatol. 1985;;12:165-167.
19 +
Symmans WA, Beresford CH, Bruton D, et al.  Cyclic eosinophilic myositis and hyperimmunoglobulin-E . Ann Intern Med. 1986;;104:26-32.
20 +
Lakhanpal S, Duffy J, Engel AG.  Eosinophilia associated with perimyositis and pneumonitis . Mayo Clin Proc. 1988;;63:37-41.
21 +
Toxic Epidemic Syndrome Study Group.  Tbxic epidemic syndrome, Spain, 1981 . Lancet. 1982;; 2:697-702.
22 +
Kilbourne EM, Rigau-Perez JG, Heath CW, et al.  Clinical epidemiology of toxic-oil syndrome . N Engl J Med. 1983;;309:1408-1414.
23 +
Grandjean P, Tarkowski S, eds. Toxic Oil Syndrome: Mass Food Poisoning in Spain: Report of a World Health Organization (WHO) Meeting: Madrid 21-25 March 1983 . Copenhagen, Denmark: WHO Regional Office for Europe; 1984;.
24 +
Martinez Tello FJ, Navas Palacios JJ, Ricoy JR, et al.  Pathology of a new toxic syndrome caused by ingestion of adulterated oil in Spain . Virchows Arch A. 1982;;397:261-285.
25 +
Kilbourne EM, Bernert JT, Posada M, et al.  Chemical correlates of pathogenicity of oils related to the toxic oil syndrome epidemic in Spain . Am J Epidemiol. 1988;;127:1210-1227.
26 +
Slutsker L, Hoesly FC, Miller L, Williams LP, Watson JC, Fleming DW.  Eosinophilia-myalgia syndrome associated with exposure to tryptophan from a single manufacturer . JAMA. 1990;;264:213-217.

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1 +
Centers for Disease Control.  Eosinophilia-myalgia syndrome—New Mexico . MMWR. 1989;;38:765-767.
2 +
Hertzman PA, Blevins WL, Mayer J, Greenfield B, Ting M, Gleich G.  Association of the eosinophilia-myalgia syndrome with the ingestion of tryptophan . N Engl J Med. 1990;;322:869-873.
3 +
Centers for Disease Control.  Eosinophilia-myalgia syndrome and L-tryptophan-containing products—New Mexico, Minnesota, Oregon, and New York, 1989 . MMWR. 1989;;38:785-788.
4 +
Kilbourne EM, Swygert LA, Philen RM, et al.  Interim guidance on the eosinophilia-myalgia syndrome . Ann Intern Med. 1990;;112:85-87.
5 +
Centers for Disease Control.  Update: eosinophilia-myalgia syndrome associated with ingestion of L-tryptophan—United States, as of January 9, 1990 . MMWR. 1990;;39:14-15.
6 +
Centers for Disease Control.  Clinical spectrum of eosinophilia-myalgia Syndrome—California . MMWR. 1990;;39:89-91.
7 +
 Projections of the population of states, by age, sex, and race: 1989 to 2010 . In: Current Population Reports . Washington, DC: Bureau of the Census; 1990;. Series P-25, No. (1053) .
8 +
 Population estimates for Puerto Rico and outlying areas: 1980 to 1988 . In: Current Population Reports . Washington, DC: Bureau of the Census; 1989. Series P-25, No. (1049) .
9 +
Centers for Disease Control.  Guidelines for evaluating surveillance systems . MMWR. 1988;; 37( (suppl) ):1-18.
10 +
Eidson M, Philen RM, Sewell CM, Voorhees R, Kilbourne EM.  L-tryptophan and eosinophilia-myalgia syndrome in New Mexico . Lancet. 1990;; 335:645-648.
11 +
Moss AJ, Levy AS, Kim I, Park YK.  Use of vitamin and mineral supplements in the United States: current users, types of products, and nutrients . In: Advance Data From Vital and Health Statistics: No 174 . Hyattsville, Md: National Center for Health Statistics; 1989;. Dept of Health and Human Services publication PHS 89-1250.
12 +
Boman B.  L-tryptophan: a rational antidepressant and a natural hypnotic? Aust N Z J Psychiatry. 1988;;22:83-97.
13 +
Wurtman JJ.  Carbohydrate craving, mood changes, and obesity . J Clin Psychiatry. 1988;; 49( (suppl) ):37-39.
14 +
Division of Epidemiology and Prevention Research.  Annual data: 1988 . In: Data From the Drug Abuse Warning Network . Rockville, Md: National Institute on Drug Abuse; 1989;; series 1( (8) ):35. Dept of Health and Human Services publication ADM 89-1634.
15 +
Weissman MM, Leaf PJ, Tischler GL, et al.  Affective disorders in five United States communities . Psychol Med. 1988;;18:141-153.
16 +
Carlson GA, Kashani JH.  Phenomenology of major depression from childhood through adulthood: analysis of three studies . Am J Psychiatry. 1988;;145:1222-1225.
17 +
Barrett JE, Barrett JA, Oxman TE, Gerber PD.  The prevalence of psychiatric disorders in a primary care practice . Arch Gen Psychiatry. 1988;;45:1100-1106.
18 +
Yonker RA, Panush RS.  Idiopathic eosinophilic myositis with preexisting fibromyalgia . J Rheumatol. 1985;;12:165-167.
19 +
Symmans WA, Beresford CH, Bruton D, et al.  Cyclic eosinophilic myositis and hyperimmunoglobulin-E . Ann Intern Med. 1986;;104:26-32.
20 +
Lakhanpal S, Duffy J, Engel AG.  Eosinophilia associated with perimyositis and pneumonitis . Mayo Clin Proc. 1988;;63:37-41.
21 +
Toxic Epidemic Syndrome Study Group.  Tbxic epidemic syndrome, Spain, 1981 . Lancet. 1982;; 2:697-702.
22 +
Kilbourne EM, Rigau-Perez JG, Heath CW, et al.  Clinical epidemiology of toxic-oil syndrome . N Engl J Med. 1983;;309:1408-1414.
23 +
Grandjean P, Tarkowski S, eds. Toxic Oil Syndrome: Mass Food Poisoning in Spain: Report of a World Health Organization (WHO) Meeting: Madrid 21-25 March 1983 . Copenhagen, Denmark: WHO Regional Office for Europe; 1984;.
24 +
Martinez Tello FJ, Navas Palacios JJ, Ricoy JR, et al.  Pathology of a new toxic syndrome caused by ingestion of adulterated oil in Spain . Virchows Arch A. 1982;;397:261-285.
25 +
Kilbourne EM, Bernert JT, Posada M, et al.  Chemical correlates of pathogenicity of oils related to the toxic oil syndrome epidemic in Spain . Am J Epidemiol. 1988;;127:1210-1227.
26 +
Slutsker L, Hoesly FC, Miller L, Williams LP, Watson JC, Fleming DW.  Eosinophilia-myalgia syndrome associated with exposure to tryptophan from a single manufacturer . JAMA. 1990;;264:213-217.

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