Toxic oil syndrome

Ladona, M.G. et al., Pharmacogenetic profile of xenobiotic enzyme metabolism in survivors of the Spanish toxic oil syndrome, Environ. Health Perspect., 109, 369-375, 2001. 

Posada de la Paz, M., Philen, R.M., Abaitua Borda, I., Sicilia Socias, J.M., Gomez de la Camara, A. and Kilbourne, E.M. (1996) Toxic oil syndrome Traceback of the toxic oil and evidence for a point source epidemic. Food Chem. Toxicol., 34, 251-257. 

For other environmental factors, the associations with autoimmunity have been suggested from epidemiologic studies and/or animal models or in vitro studies. Dietary factors such as iodine, nutritional supplements such as omega fatty acids, and food contaminants such as those found in the cooking oil associated with toxic oil syndrome have been linked with autoimmune disorders. Table 32.9 lists a number... 

ON I May 1981 an 8-year-old boy died in Madrid, apparently from a respiratory disease. Later six more members of the family feU iU with similar symptoms. Within a week at least 150 cases a day were being recorded and by June there were 2,000 cases in hospitals in Madrid. Over 20,000 cases were eventually recorded and there were 351 deaths. The epidemic became known as the toxic oil syndrome and attracted worldwide attention and scientific interest. It was the result of the illicit sale and use of contaminated oil for cooking. This relatively recent example shows how vulnerable we canbeto contaminants in our food (see below pp. 263-5). 

P Grandjean and S. Tarkowski (eds.). Toxic Oil Syndrome Mass Food Poisoning in Spain, Report on a WHO Meeting Madrid, 21-25 Mar. 1983, Copenhagen, World Health Organization, 1984. 

Some oilseeds are dried in the field with hot gases from oil burners. Copra is often dried in ovens or kilns fired by coconut shells. In each case, contamination with diesel fuel fumes or polyaromatic hydrocarbons is inevitable. The only question is to what extent. Some hydrocarbons occur naturally in plants and appear in plant products. Mineral oil contamination of vegetable oil was also associated with toxic oil syndrome (20). 

Solis-Herrnzo, J.A., Vidal, J.V, Colina, F., Castellano, G., Mnnoz-Yague, M.T., Morillas, J.D. Clinico-biochemical evolution and late hepatic lesions in the toxic oil syndrome. Gastroenterology 1987 93 558-568... 

Velicia, R., Sanz, C., Martinez-Barredo, F., Sanchez-Tapias, JJM., Bru-guera, M., Rodes, X Hepatic disease in the Spanish Toxic Oil Syndrome. A thirty months follow-up study. J. Hepatol. 1986 3 59-65... 

The majority of patients also had an elevated leukocyte count with modestly elevated levels of aldolase, a marker of muscle injury however, creatine phosphokinase, another indicator of muscle injury, was normal in most patients. This inconsistency between the levels of these two muscle-associated enzymes, previously described in some patients with systemic sclerosis and the toxic oil syndrome (TOS) (see below), is helpful in differentiating EMS from other myopathies (muscle diseases) and from eosinophilic fasciitis (EE) (see below). Approximately one-half of patients had abnormal liver function tests, although the changes were mild. The erythrocyte sedimentation rate, rheumatoid factor, and levels of IgE, complement, and cryoglobulin (all markers of immune dysfunction) were normal in most patients tested. 

According to Verity et al.,43 the described pathologic changes in skin, fascia, and muscle, along with the defined clinical syndrome of EMS, allow for an accurate differentiation from related syndromes, including eosinophilia polymyositis, scleroderma, idiopathic polymyositic/dermatomyositis, polyarteritis nodosa, and toxic oil syndrome.43 A few reports have considered the comparison of the histopathologic features of Shulman s syndrome (diffuse fasciitis with eosinophilia) and the fasciitis associated with EMS.43... 

Pathologic findings in the heart have been described.49 50 Pathologic lesions are present in the coronary arteries, neural structures, and conduction system of the heart.50 James et al.51 reported that the cardiac abnormalities in the toxic oil syndrome resemble those described in EMS. 

Possible Relationship between Eosiniophilia Myalgia Syndrome and Toxic Oil Syndrome... 

In 1981, another poorly understood epidemic, the toxic oil syndrome (TOS), occurred in Spain.69 71 It was associated with ingestion of adulterated rapeseed oil.120 The pathology of TOS has been described.72 It is of interest that many of the clinical and histopathologic features of TOS resemble those of EMS.36 73... 

Mayeno et al.8 reported that PAA could become metabolized to 3-phenyl-amino-l,2-propane-diol (PAP), a compound that was found to be contaminating the rapeseed oil consumed by individuals who developed the toxic oil syndrome in Spain in 1981.74... 

Mayeno, A. N., Belongia, E. A., Lin, F., Lundy, S. K., and Gleich, G. J., 3-(Phenyl-amino)alanine, a novel aniline-derived amino acid associated with the eosinophilia-myalgia syndrome A link to the toxic oil syndrome Mayo Clin. Proc., 67, 1134, 1992. 

James, T. N., Gomez-Sanchez, M. A., Martinez-Tello, F. J., Posada-de la Paz, M., Abaitua-Borda, I., and Soldevilla, L. B., Cardiac abnormalities in the toxic oil syndrome, with comparative observations on the eosinophilia-myalgia syndrome, /. Am. Coll. Cardiol., 18, 1367, 1991. 

Kaufman, L. D., Gruber, B. L., Gomez-Reino, J. J., and Miller, F., Fibrogenic growth factors in the eosinophilia-myalgia syndrome and the toxic oil syndrome, Arch. Dermatol., 130, 41, 1994. 

Carreira, P. E., Montalvo, M. G., Kaufman, L. D., Silver, R. M., Izquierdo, M., and Gomez-Reino, J. J., Antiphospholipid antibodies in patients with eosino-philia myalgia and toxic oil syndrome, /. Rheumatol., 24, 69, 1997. 

Scleroderma-like manifestation is a typical clinical feature of the toxic oil syndrome (see chapter 7). 

In 1981-1982, an epidemic spread across Spain, which was eventually labelled the toxic oil syndrome by the World Health Organization (WHO). In less than two years, at least 20 096 people were afflicted by and 356 people died from toxic oil syndrome (Philen et al., 1997 Philen Dicker, 2000). Women, especially those less than 40 years of age, were affected more severely than men 61% of the victims and 66% of the deaths were women (Sanchez-Porro Valades et al., 2003). Toxic oil syndrome has striking similarities to autoimmune diseases, particularly scleroderma. In addition, it resembles eosinophilia myalgia syndrome and diffuse fasciitis with eosinophilia. Toxic oil syndrome-associated manifestations evolved from initiating vasculitis to eosinophilia in the acute phase and then sicca syndrome, neuropathy, scleroderma, Raynaud phenomenon, and musculoskeletal inflammation in the chronic phase (Kaufman Krupp, 1995). More than 70% of toxic oil syndrome patients presented with eosinophilia, regardless of age or sex. 

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