The Experts below are selected from a list of 273 Experts worldwide ranked by ideXlab platform
Richard M. Silver - One of the best experts on this subject based on the ideXlab platform.
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The Eosinophilia-Myalgia Syndrome: Status of 205 Patients and Results of Treatment 2 Years after Onset
Annals of internal medicine, 1995Co-Authors: Phillip A. Hertzman, Luis R. Espinoza, John Varga, Richard M. Silver, Holly L. Thacker, Daniel J. Clauw, Lee D. Kaufman, Phillip Mease, Theodore PincusAbstract:Objective: To describe the course of the Eosinophilia-Myalgia Syndrome during a 2-year period. Design: 15 physicians completed a structured review form to describe symptoms, physical findings, labo...
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Eosinophilia-Myalgia Syndrome, toxic-oil Syndrome, and diffuse fasciitis with Eosinophilia.
Current opinion in rheumatology, 1994Co-Authors: M B Bolster, Richard M. SilverAbstract:Eosinophilia-Myalgia Syndrome, a recently described illness, reached epidemic proportions in 1989 and was linked to the ingestion of L-tryptophan containing trace amounts of several contaminants. Eosinophilia-Myalgia Syndrome shares many clinical and pathologic similarities with toxic-oil Syndrome, an epidemic linked to the ingestion of adulterated cooking oil that occurred in Spain in 1981, and to diffuse fasciitis with Eosinophilia, a condition first described in 1974. Over the past year, much work has been done in understanding the etiology and pathogenesis of Eosinophilia-Myalgia Syndrome and toxic-oil Syndrome. Follow-up data detailing the long-term sequelae and mortality rates for these two conditions are becoming available. The results from these studies are reviewed in this paper.
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The Eosinophilia-Myalgia Syndrome
Clinics in dermatology, 1994Co-Authors: Richard M. SilverAbstract:A seemingly new illness was first described in the United States in late 1989, when physicians in New Mexico reported the occurrence #of generalized Myalgia and Eosinophilia in three women, each of whom had a prior history of ingesting the amino acid, L-tryptophan.’ The illness, which has been linked to the ingestion of L-tryptophan containing trace amounts of chemical contaminants reached epidemic proportions in late 1989, and it quickly subsided when L-tryptophan containing products were recalled. This illness, now known as the Eosinophilia -Myalgia Syndrome (EMS), was frequently complicated by the occurrence of sclerodermalike hardening of the skin and subcutaneous tissues and, thus, may be added to a growing list of environmental or toxin exposures implicated in the pathogenesis of sclerodermatous disorders. EMS shares many features with diffuse fasciitis with Eosinophilia (DFE or Shulman’s disease),2 as well as with the toxic oil Syndrome (TOS), another sclerodermalike disease which occurred as an epidemic in 1981, affecting nearly 20,000 individuals in Spain.3 The study of EMS and related conditions is important, not only for the sake of public health, but also for the insight which may be gained for better understanding of systemic sclerosis (SSc) and other fibrosing cutaneous processes.
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Eosinophilia-Myalgia Syndrome, toxic-oil Syndrome, and diffuse fasciitis with Eosinophilia.
Current Opinion in Rheumatology, 1993Co-Authors: Richard M. SilverAbstract:Eosinophilia-Myalgia Syndrome reached epidemic proportions in 1989. Its precise etiology remains uncertain, yet virtually all cases were associated with the ingestion of L-tryptophan containing trace amounts of several chemicals. Clinical and pathologic features of Eosinophilia-Myalgia Syndrome are similar to those of the toxic-oil Syndrome, which occurred in Spain in 1981 in association with the ingestion of adulterated rapeseed oil. During the past year, the epidemiology of Eosinophilia-Myalgia Syndrome has been better defined, with a second trace contaminant linked to this condition. Knowledge of the clinical and histopathologic features of Eosinophilia-Myalgia Syndrome has also expanded. These and other important advances in the understanding of Eosinophilia-Myalgia Syndrome, toxic-oil Syndrome, and diffuse fasciitis with Eosinophilia are presented. Language: en
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Eosinophilia-Myalgia Syndrome, toxic-oil Syndrome, and diffuse fasciitis with Eosinophilia.
Current opinion in rheumatology, 1993Co-Authors: Richard M. SilverAbstract:Eosinophilia-Myalgia Syndrome reached epidemic proportions in 1989. Its precise etiology remains uncertain, yet virtually all cases were associated with the ingestion of L-tryptophan containing trace amounts of several chemicals. Clinical and pathologic features of Eosinophilia-Myalgia Syndrome are similar to those of the toxic-oil Syndrome, which occurred in Spain in 1981 in association with the ingestion of adulterated rapeseed oil. During the past year, the epidemiology of Eosinophilia-Myalgia Syndrome has been better defined, with a second trace contaminant linked to this condition. Knowledge of the clinical and histopathologic features of Eosinophilia-Myalgia Syndrome has also expanded. These and other important advances in the understanding of Eosinophilia-Myalgia Syndrome, toxic-oil Syndrome, and diffuse fasciitis with Eosinophilia are presented.
John Varga - One of the best experts on this subject based on the ideXlab platform.
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Eosinophilia–Myalgia Syndrome
Encyclopedia of Toxicology, 2014Co-Authors: Jeffrey A. Allen, John VargaAbstract:Eosinophilia–Myalgia Syndrome (EMS) is a multisystem disease characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to l-tryptophan consumption originating from a single source. Following the US Food and Drug Administration ban on the sale of l-tryptophan, EMS incidence declined rapidly. Xenobiotic triggered acute inflammation in a genetically susceptible host likely mediates the early phase of EMS. Late in the disease, cytokine activation and upregulation of collagen and extracellular matrix genes may drive the sustained fibrotic response. The exact etiologic agent responsible for EMS remains unknown.
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Eosinophilia Myalgia Syndrome
Reference Module in Biomedical Sciences#R##N#Encyclopedia of Toxicology (Third Edition), 2014Co-Authors: Jeffrey A. Allen, John VargaAbstract:Eosinophilia–Myalgia Syndrome (EMS) is a multisystem disease characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to l-tryptophan consumption originating from a single source. Following the US Food and Drug Administration ban on the sale of l-tryptophan, EMS incidence declined rapidly. Xenobiotic triggered acute inflammation in a genetically susceptible host likely mediates the early phase of EMS. Late in the disease, cytokine activation and upregulation of collagen and extracellular matrix genes may drive the sustained fibrotic response. The exact etiologic agent responsible for EMS remains unknown.
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post epidemic Eosinophilia Myalgia Syndrome associated with l tryptophan
Arthritis & Rheumatism, 2011Co-Authors: Jeffrey A. Allen, Alicia Peterson, Robert L Sufit, Monique Hinchcliff, Matthew J Mahoney, Tammara A Wood, Frederick W Miller, Michael L Whitfield, John VargaAbstract:Eosinophilia-Myalgia Syndrome (EMS) is characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to consumption of L-tryptophan that had originated from a single source. Following the ban by the Food and Drug Administration (FDA) on the sale of L-tryptophan, the incidence of EMS declined rapidly. Moreover, no new cases have been described since the FDA ban was lifted in 2005. We report the clinical, histopathologic, and immunogenetic features of a new case of L-tryptophan-associated EMS, along with evidence of activated transforming growth factor β and interleukin-4 signaling in the lesional skin.
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Post‐epidemic Eosinophilia–Myalgia Syndrome associated with L‐tryptophan
Arthritis and rheumatism, 2011Co-Authors: Jeffrey A. Allen, Alicia Peterson, Robert L Sufit, Monique Hinchcliff, Tammara A Wood, Frederick W Miller, Michael L Whitfield, J. Matthew Mahoney, John VargaAbstract:Eosinophilia-Myalgia Syndrome (EMS) is characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to consumption of L-tryptophan that had originated from a single source. Following the ban by the Food and Drug Administration (FDA) on the sale of L-tryptophan, the incidence of EMS declined rapidly. Moreover, no new cases have been described since the FDA ban was lifted in 2005. We report the clinical, histopathologic, and immunogenetic features of a new case of L-tryptophan-associated EMS, along with evidence of activated transforming growth factor β and interleukin-4 signaling in the lesional skin.
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Eosinophilia-Myalgia Syndrome, eosinophilic fasciitis, and related fibrosing disorders.
Current opinion in rheumatology, 1997Co-Authors: Jeffrey A. Allen, John VargaAbstract:The fasciitis disorders share clinical and histopathological features with systemic sclerosis, the prototype systemic fibrosing disorder. The fibrosing disorders are heterogeneous category of conditions and include eosinophilic fasciitis (diffuse fasciitis with Eosinophilia), Eosinophilia-Myalgia Syndrome, and the toxic oil Syndrome, discussed in details in this chapter.
Edwin M. Kilbourne - One of the best experts on this subject based on the ideXlab platform.
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Tryptophan Contaminants Associated with Eosinophilia-Myalgia Syndrome
American journal of epidemiology, 1993Co-Authors: Rossanne M. Philen, Henry Falk, Robert H. Hill, W. D Flanders, Samuel P. Caudill, Larry L. Needham, Sewell L, Eric J. Sampson, Edwin M. KilbourneAbstract:Eosinophilia-Myalgia Syndrome (EMS) has been linked to ingestion of tryptophan contaminated with 1,1'-ethylidene-bis[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 (p = 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.
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Eosinophilia-Myalgia Syndrome in L-Tryptophan—Exposed Patients
JAMA, 1992Co-Authors: Mary L. Kamb, John J. Murphy, Jeffrey L. Jones, J. Christopher Caston, Kees Nederlof, Louise F. Horney, Leslie A. Swygert, Henry Falk, Edwin M. KilbourneAbstract:Objectives. —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. Design. —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. Setting. —Office practice of one psychiatrist based in a small city (population 43467) in South Carolina. Patients. —Eligible subjects were all patients from the practice who used L-tryptophan during the 1989 study interval. Of these, 418 (87%) were interviewed. Main Outcome Measures. —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. (JAMA. 1992;267:77-82)
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Eosinophilia Myalgia Syndrome in l tryptophan exposed patients
JAMA, 1992Co-Authors: Mary L. Kamb, John J. Murphy, Jeffrey L. Jones, Kees Nederlof, Louise F. Horney, Leslie A. Swygert, Henry Falk, Christopher J Caston, Edwin M. KilbourneAbstract:Objectives. —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. Design. —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. Setting. —Office practice of one psychiatrist based in a small city (population 43467) in South Carolina. Patients. —Eligible subjects were all patients from the practice who used L-tryptophan during the 1989 study interval. Of these, 418 (87%) were interviewed. Main Outcome Measures. —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. (JAMA. 1992;267:77-82)
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Postmortem studies of the heart in three fatal cases of the Eosinophilia-Myalgia Syndrome.
Annals of internal medicine, 1991Co-Authors: Thomas N. James, Richard M. Silver, Mary L. Kamb, Glory A. Sandberg, Edwin M. KilbourneAbstract:▪ Objective: To examine the hearts of individuals who died from the Eosinophilia-Myalgia Syndrome associated with ingestion of L-tryptophan, with particular attention paid to the coronary arteries,...
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Eosinophilia Myalgia Syndrome a clinical case series of 21 patients new mexico Eosinophilia Myalgia Syndrome study group
JAMA Internal Medicine, 1991Co-Authors: R M Philen, Edwin M. Kilbourne, Millicent Eidson, C M Sewell, Ron VoorheesAbstract:We reviewed 21 cases of Eosinophilia-Myalgia Syndrome to describe the range of clinical findings in these patients. Most patients were women (20 [95%]) and middle-aged (mean, 46 years) and had taken the food supplement L-tryptophan (95%). All cases involved Eosinophilia (eosinophil count, greater than or equal to 2.0 x 10(9)/L) and incapacitating Myalgias. Fourteen (88%) of the 16 patients tested had mild liver function abnormalities. Aldolase levels were abnormal in all patients tested. Muscle biopsies were done in five patients; four showed eosinophilic perimyositis, and one had interstitial inflammation. No physical finding was pathognomonic or universal, but muscle tenderness, tachycardia, and rash were the most common signs found during physical examinations. Seven patients were treated with prednisone, and six showed improvement in muscle pain and a decrease in Eosinophilia. The cause of this disorder is still unknown.
P. Yang - One of the best experts on this subject based on the ideXlab platform.
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Gastrointestinal involvement inl-tryptophan (l-trp) associated Eosinophilia-Myalgia Syndrome (EMS)
Digestive Diseases and Sciences, 1992Co-Authors: K. Schryver-kecskemeti, K. W. Bennert, G. S. Cooper, P. YangAbstract:We report a 45-year-old female who had symptomatic gastrointestinal involvement, eosinophils in the cellular infiltrate, and who proved to have l -tryptophan-associated Eosinophilia-Myalgia Syndrome. This case illustrates that gastrointestinal disease can be a major, seemingly primary clinical presentation in this Syndrome, and that a drug history, specifically l -tryptophan, needs to be included in the differential diagnosis of “eosinophilic gastroenteritis.”
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Gastrointestinal involvement in L-tryptophan (L-Trp) associated Eosinophilia-Myalgia Syndrome (EMS).
Digestive diseases and sciences, 1992Co-Authors: K. Schryver-kecskemeti, K. W. Bennert, G. S. Cooper, P. YangAbstract:We report a 45-year-old female who had symptomatic gastrointestinal involvement, eosinophils in the cellular infiltrate, and who proved to havel-tryptophan-associated Eosinophilia-Myalgia Syndrome. This case illustrates that gastrointestinal disease can be a major, seemingly primary clinical presentation in this Syndrome, and that a drug history, specificallyl-tryptophan, needs to be included in the differential diagnosis of “eosinophilic gastroenteritis.”
Jeffrey A. Allen - One of the best experts on this subject based on the ideXlab platform.
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Eosinophilia–Myalgia Syndrome
Encyclopedia of Toxicology, 2014Co-Authors: Jeffrey A. Allen, John VargaAbstract:Eosinophilia–Myalgia Syndrome (EMS) is a multisystem disease characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to l-tryptophan consumption originating from a single source. Following the US Food and Drug Administration ban on the sale of l-tryptophan, EMS incidence declined rapidly. Xenobiotic triggered acute inflammation in a genetically susceptible host likely mediates the early phase of EMS. Late in the disease, cytokine activation and upregulation of collagen and extracellular matrix genes may drive the sustained fibrotic response. The exact etiologic agent responsible for EMS remains unknown.
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Eosinophilia Myalgia Syndrome
Reference Module in Biomedical Sciences#R##N#Encyclopedia of Toxicology (Third Edition), 2014Co-Authors: Jeffrey A. Allen, John VargaAbstract:Eosinophilia–Myalgia Syndrome (EMS) is a multisystem disease characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to l-tryptophan consumption originating from a single source. Following the US Food and Drug Administration ban on the sale of l-tryptophan, EMS incidence declined rapidly. Xenobiotic triggered acute inflammation in a genetically susceptible host likely mediates the early phase of EMS. Late in the disease, cytokine activation and upregulation of collagen and extracellular matrix genes may drive the sustained fibrotic response. The exact etiologic agent responsible for EMS remains unknown.
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post epidemic Eosinophilia Myalgia Syndrome associated with l tryptophan
Arthritis & Rheumatism, 2011Co-Authors: Jeffrey A. Allen, Alicia Peterson, Robert L Sufit, Monique Hinchcliff, Matthew J Mahoney, Tammara A Wood, Frederick W Miller, Michael L Whitfield, John VargaAbstract:Eosinophilia-Myalgia Syndrome (EMS) is characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to consumption of L-tryptophan that had originated from a single source. Following the ban by the Food and Drug Administration (FDA) on the sale of L-tryptophan, the incidence of EMS declined rapidly. Moreover, no new cases have been described since the FDA ban was lifted in 2005. We report the clinical, histopathologic, and immunogenetic features of a new case of L-tryptophan-associated EMS, along with evidence of activated transforming growth factor β and interleukin-4 signaling in the lesional skin.
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Post‐epidemic Eosinophilia–Myalgia Syndrome associated with L‐tryptophan
Arthritis and rheumatism, 2011Co-Authors: Jeffrey A. Allen, Alicia Peterson, Robert L Sufit, Monique Hinchcliff, Tammara A Wood, Frederick W Miller, Michael L Whitfield, J. Matthew Mahoney, John VargaAbstract:Eosinophilia-Myalgia Syndrome (EMS) is characterized by subacute onset of Myalgias and peripheral Eosinophilia, followed by chronic neuropathy and skin induration. An epidemic of EMS in 1989 was linked to consumption of L-tryptophan that had originated from a single source. Following the ban by the Food and Drug Administration (FDA) on the sale of L-tryptophan, the incidence of EMS declined rapidly. Moreover, no new cases have been described since the FDA ban was lifted in 2005. We report the clinical, histopathologic, and immunogenetic features of a new case of L-tryptophan-associated EMS, along with evidence of activated transforming growth factor β and interleukin-4 signaling in the lesional skin.
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Eosinophilia-Myalgia Syndrome, eosinophilic fasciitis, and related fibrosing disorders.
Current opinion in rheumatology, 1997Co-Authors: Jeffrey A. Allen, John VargaAbstract:The fasciitis disorders share clinical and histopathological features with systemic sclerosis, the prototype systemic fibrosing disorder. The fibrosing disorders are heterogeneous category of conditions and include eosinophilic fasciitis (diffuse fasciitis with Eosinophilia), Eosinophilia-Myalgia Syndrome, and the toxic oil Syndrome, discussed in details in this chapter.