Eosinophilia
-
myalgia
syndrome
(
EMS
)
was
first
recognized
in
1989
in
New
Mexico
in
3
____________________
who
had
an
illness
with
a
unique
array
of
____________________
,
including
peripheral
blood
eosinophilia
and
severe
myalgias
.
All
3
patients
____________________
ingested
sleeping
aids
containing
L
-
tryptophan
.
In
the
ensuing
weeks
,
____________________
nationwide
epidemic
of
EMS
became
apparent
;
this
epidemic
was
____________________
with
the
use
of
over
-
the
-
counter
compounds
____________________
L
-
tryptophan
.
In
response
,
the
US
Food
and
Drug
Administration
ordered
a
____________________
of
all
single
-
entity
products
containing
L
-
tryptophan
.
In
1989
,
the
Centers
for
Disease
Control
and
Prevention
(
CDC
)
issued
the
____________________
case
definition
for
EMS
:
(
1
)
a
peripheral
eosinophil
count
of
at
least
1
.
0
X
109
cells
/
L
,
(
2
)
a
____________________
myalgia
at
some
point
during
the
illness
that
____________________
severe
enough
to
affect
the
patient's
ability
to
perform
his
or
her
____________________
daily
activities
,
and
(
3
)
no
evidence
of
infection
or
neoplasm
____________________
could
explain
either
the
eosinophilia
or
the
myalgia
.
EMS
may
be
related
____________________
the
toxic
oil
syndrome
in
Spain
.
They
are
linked
____________________
a
common
toxic
metabolite
(
4
-
aminophenol
)
and
may
be
further
associated
by
the
concomitant
release
of
potentially
hazardous
carbonyl
species
.
The
US
Food
and
Drug
Administration
banned
the
sale
of
L
-
tryptophan
,
resulting
EMS
declining
rapidly
.
This
ban
____________________
lifted
in
2005
.
A
new
case
was
described
in
2011
.
____________________
the
daily
nutritional
requirement
for
L
-
tryptophan
is
only
5
mg
/
kg
,
many
people
continue
to
ingest
much
more
,
often
to
improve
mood
or
sleep
.
