Idiopathic and L-tryptophan-associated eosinophilic fasciitis before and after L-tryptophan contamination

Blauvelt, A.

doi:10.1001/archderm.127.8.1159

Cited by 20 publications

(13 citation statements)

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“…Eosinophilia-myalgia syndrome in the late eighties was largely induced by ingestion of L -tryptophan [3, 29]. Some cases of EF are reported after L -tryptophan ingestion, suggesting an overlap in the pathogenesis [30, 31]. …”

Section: Discussionmentioning

confidence: 99%

Eosinophilic Fasciitis 30 Years after – What Do We Really Know?

Antic¹,

2006

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Background: Eosinophilic fasciitis (EF) is a rare fibrosing disorder associated with peripheral eosinophilia and scleroderma-like induration of the distal extremities which affects substantially quality of life. Although the disease has been described 30 years ago, the etiology and pathomechanisms are still obscure, and consensus for therapy is lacking. Numerous case reports of patients with EF exist but series are scarce. Patients and Methods: Eleven patients with EF from the Department of Dermatology, Kantonsspital Aarau, the University Hospital Basel and the Outpatient Clinic of Dermatology, Triemli Hospital Zurich, Switzerland, were retrospectively studied. Results: In 4 patients the initial diagnosis was not recognized by the referring nondermatologists. The median age was 55 years, excluding the youngest patient ever diagnosed with EF (age = 1 year). All patients showed an induration of the skin, which led to painful contractures in the joints in 3 cases. All but 2 patients demonstrated edema. A slight predominance of the upper extremities was observed. Sclerodactyly was noticed in 1 patient. Three patients reported an initial trauma at the affected site. Two patients were tested positive for borreliosis. One patient subsequently developed aplastic anemia and Hashimoto thyroiditis. Visceral or extracutaneous involvement was absent. Eight patients had a full or partial recovery under corticosteroids whereas in 2, improvement could be achieved only with cyclosporine, azathioprine or cyclophosphamide. Conclusions: The diagnosis of EF can be established by clinical, laboratory and histological findings. In general, corticosteroids are highly efficacious in EF and only a minority of patients need other immunosuppressive or cytostatic drugs.

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Section: Discussionmentioning

confidence: 99%

Eosinophilic Fasciitis 30 Years after – What Do We Really Know?

Antic¹,

2006

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“…Eosinophilia-myalgia syndrome, which not only shares the symptoms of EF but also includes visceral involvement, was found to be associated with the consumption of L-tryptophan. In some cases of EF there had also been a history of L-tryptophan ingestion indicating that there might be an overlap in the pathogenesis [2,6].…”

Section: Introductionmentioning

confidence: 99%

Eosinophilic fasciitis leading to painless contractures

et al. 2002

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“…15 IL-5 was not elevated in another EMS patient unexposed to LTCDS [323]. 16 5-HIAA is a serotonin metabolite. 17 IAA is a tryptamine metabolite.…”

Section: Indoleamine Overloads and Compromised Histamine Metabolismmentioning

confidence: 94%

“…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%

“…Pervasive hypothesis, two alleged (and partially interrelated) cofactorsnamely, genetic engineering and a microimpurity/ies of dietary supplements [15] -are both unnecessary and insuffi cient explanations of enigmatic (multifactorial) 4 chains of causality underlying a majority of offi cial EMS cases. Numerous etiologic incongruities [16][17][18][19] -including two reports of L-tryptophan-induced eosinophilia with myalgia in 1986 [20][21][22] -underscore why a paradigm shift was advisable. According to several analytical surveys, incriminated tryptophan met Pharmacopeia criteria (DAB 9) for products intended for medicinal purposes in Germany [23].…”

Section: Introductionmentioning

confidence: 99%

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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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Idiopathic and L-tryptophan-associated eosinophilic fasciitis before and after L-tryptophan contamination

Cited by 20 publications

References 0 publications

Eosinophilic Fasciitis 30 Years after – What Do We Really Know?

Eosinophilic Fasciitis 30 Years after – What Do We Really Know?

Eosinophilic fasciitis leading to painless contractures

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

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