title: Eosinophilia-myalgia syndrome in L-tryptophan-exposed patients.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  Office practice of one psychiatrist based in a small city (population 43,467) in South Carolina.
  
  
  METHODS
  Eligible subjects were all patients from the practice who used L-tryptophan during the 1989 study interval. Of these, 418 (87%) were interviewed.
  
  
  METHODS
  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.
authors.affiliation: Centers for Disease Control, Public Health Service, US Department of Health and Human Services, Atlanta, Ga. 30333.
authors.forename: M L
authors.initials: ML
authors.lastname: Kamb
authors.forename: J J
authors.initials: JJ
authors.lastname: Murphy
authors.forename: J L
authors.initials: JL
authors.lastname: Jones
authors.forename: J C
authors.initials: JC
authors.lastname: Caston
authors.forename: K
authors.initials: K
authors.lastname: Nederlof
authors.forename: L F
authors.initials: LF
authors.lastname: Horney
authors.forename: L A
authors.initials: LA
authors.lastname: Swygert
authors.forename: H
authors.initials: H
authors.lastname: Falk
authors.forename: E M
authors.initials: EM
authors.lastname: Kilbourne
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D015331:Cohort Studies; D016603:Eosinophilia-Myalgia Syndrome / Q000139:chemically induced*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012621:Seasons; D014364:Tryptophan / Q000009:adverse effects*
chemical_list: D014364:Tryptophan