Eosinophilic fasciitis associated with tryptophan ingestion. A manifestation of eosinophilia-myalgia syndrome

Gordon, M. L.

doi:10.1001/archderm.127.2.217

Cited by 7 publications

(2 citation statements)

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“…EF shares many clinical similarities with eosinophila‐myalgia syndrome and Spanish toxic oil syndrome from ingestion of contaminated L‐tryptophan and rapeseed oil (described later). In the latter 2 conditions, pulmonary involvement is more common than in cases of EF without a history of exposure to toxins, although previously these entities were thought to represent a clinical spectrum from a common disease process . In 1 of the larger case series of 52 EF patients, Lakhanpal et al .…”

Section: Discussionmentioning

confidence: 99%

Eosinophilic fasciitis with subjacent myositis

et al. 2017

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Section: Discussionmentioning

confidence: 99%

Eosinophilic fasciitis with subjacent myositis

et al. 2017

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“…Of eight examined subjects with L-tryptophan-induced EMS, four had elevated urinary 5-hydroxyindoleacetic acid (5-HIAA) 16 long after discontinuing LTCDS use; tryptamine and indole-3-acetic acid (IAA) 17 levels appeared normal [97]. Compared to the minimal recommended daily intake of L-tryptophan (i. e., 200 mg day -1 [98]), typical Western diets contain approximately 1 g day -1 according to some reports [99]; others suggest this approximation is an underestimate [100,101].…”

Section: Unobtrusive Implications Concerning Incurred Indoleamines Anmentioning

confidence: 99%

A heretofore undisclosed crux of Eosinophilia-Myalgia Syndrome: compromised histamine degradation

Smith

Garrett

2005

Inflamm. res.

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In contrast to early epidemiological evidence offering links between eosinophilia-myalgia syndrome (EMS) and microimpurities of L-tryptophan-containing dietary supplements (LTCDS), this account shows why reliance on a finite impurity from one manufacturer is both unnecessary and insufficient to explain the etiology of EMS. Excessive histamine activity has induced blood eosinophilia and myalgia (Greek: mys, muscle + algos, pain). Termination of the multiple actions of histamine is dependent on particular amine oxidases and histamine-N-methyltransferase. Histamine metabolism is rapid when these degradative reactions are operative. The latent effects of incurred histamine can be potentiated and aggravating when these mechanisms are impaired. Overloads of tryptophan supplements cause - among other relevant side-effects - an increased formation of formate and indolyl metabolites, several of which inhibit the degradation of histamine. Moreover, (non-EMS) subjects with hypothalamic-pituitary- adrenal (HPA) axis dysregulation have also manifested greatly increased sensitivities to incurred tryptophan and histamine. A final common pathway for syndromes characterized by eosinophilia with myalgia is now evident.

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