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American Journal of Epidemiology Vol. 138, No. 3: 154-159
Copyright © 1993 by The Johns Hopkins University School of Hygiene and Public Health

research-article

Tryptophan Contaminants Associated with Eosinophilia-Myalgia Syndrome

Rossanne M. Philen1,, Robert H. Hill, Jr.2, W. Dana Flanders1, Samuel P. Caudill2, Larry Needham2, Leeann Sewell1, Eric J. Sampson2, Henry Falk1, Edwin M. Kilbourne3 and Eosinophilia-Myalgia Studies of Oregon, New York, and New Mexico

1Division of Environmental Hazards and Health Effects, National Center for Environmental Health, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services Atlanta, GA
2Division of Environmental Health Laboratory Sciences, National Center for Environmental Health, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services Atlanta, GA
3Epidemiology Program Office, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services Atlanta, GA

Reprint requests to Dr. Rossanne M. Philen, Medical Epidemiologist, Health Studies Branch, Division of Environmental Hazards and Health Effects (F-46), National Center for Environmental Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Atlanta, GA 30341–3724

Eosinophilia-myalgia syndrome (EMS) has been linked to ingestion of tryptophan contaminated with 1,1'-ethylidenebis[L-tryptophan] (EBT), but other contaminants have received little study. The authors identified 101 lots of L-tryptophan that had been consumed either by persons with EMS or by asymptomatic tryptophan users and quantified the amounts of EBT and five other contaminants in each lot. After stratification of case and noncase lots by time of manufacture to adjust for the strong sequential pattern over time among case and noncase lots, higher EBT levels were still associated with a lot's case status, but the association lacked statistical significance ({rho} = 0.120, odds ratio = 1.56, 95% confidence interval 0.758–3.23). While these findings do not rule out the possibility that EBT is the etiologic agent in EMS, they raise the possibility that other chemical contaminants in manufactured tryptophan modify the effects of EBT or that the causal agent of EMS is an entirely distinct compound.

eosinophilia; eosinophilia-myalgia syndrome; tryptophan


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