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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 increase3ed.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.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. |
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