The ASIA syndrome: basic concepts

Abstract

The autoimmune/inflammatory syndrome induced by adjuvants (ASIA), also known as Shoenfeld's syndrome, encompasses several autoimmune conditions/phenomena that are induced following the exposure to substances with adjuvant activity. The disease spectrum is heterogeneous in respect to clinical presentation as well as severity of the clinical manifestations. Adjuvants are included in vaccination formulations for their immunogenic properties. Despite being generally well tolerated, safe and effective, some genetically predisposed individuals can develop generalized non-specific constitutional symptoms, autoantibody production, new onset, or worsening of disease presentation. In this review, we focus on the current knowledge presented in the literature on ASIA syndrome, increasing physician awareness about the basic concepts of ASIA syndrome and highlight the devastating amount of data accumulated in the last few years concerning the relationship between various adjuvants and autoimmunity.

Classical Examples of the Concept of the ASIA Syndrome

“…Autoimmune/Inflammatory syndrome induced by adjuvants (ASIA) was first introduced in 2011 by Shoenfeld et al [ 1 ] and encompasses a cluster of immune mediated diseases, which are likely to develop among genetically predisposed individuals after the exposure to an adjuvant. These conditions share several clinical aspects with the possible appearance of autoantibodies, and trend to improve once the inciting agent is removed [ 2 ]. Clustering of autoimmune diseases (AID) in families is well recognized, supporting a common genetic background [ 3 ].…”

COVID-19 Vaccine Research and Ethical Issues in the Context of Gene Editing Technologies

“…Adjuvanlar, aşılardaki antijenlerin immünojenitesini artırmak için kullanılan yardımcı maddelerdir. Adjuvanların insan sağlığı üzerinde nadiren de olsa zararlı etkileri olduğu sık sık dile getirilmekle beraber, yapılan çok yönlü ve çok merkezli çalışmalarda bu iddialar doğrulanamamıştır (29)(30)(31). Bununla beraber, aşıların özelikle geç yan etkileriyle ilgili iddiaları bilimsel olarak doğrulamak veya yanlışlamak her zaman mümkün olamayabilir.…”

Autoimmune/inflammatory syndrome induced by buttock augmentation with silicone

“…There are emerging reports of autoimmune-like phenomena in patients with silicone exposure, coined ASIA syndrome (autoimmune/inflammatory syndrome induced by adjuvants) [ 1 ]. Clinical presentation and severity can be heterogeneous.…”

“…Silicone may cause an amplified immune response by promoting cytokine release and T-cell proliferation, reacting with mucopolysaccharides in connective tissue and causing granulomatous reactions [ 1 ]. Therapeutic options include antibiotics such as minocycline, immunomodulation with CSs or etanercept, and surgical excision.…”