Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) is a group of conditions that some people develop after being exposed to components used in some medications, vaccines, or materials in medical devices, cosmetic elements, and tattoo-inks. It results from an exaggerated immune response triggered by the adjuvant.
In vaccines and medications, adjuvants act as carriers of molecules, storage depots and stimulators of the body’s immunological (defense) system, enhancing the effectiveness of the medical substance administered to the individual (1). In medical devices and implants, materials such as silicone or metals are essential to the structure of the element.
Patients with ASIA syndrome experience an unexplained variety of symptoms, including chronic fatigue, muscle pain, joint pain, and cognitive disturbances (problems with thinking, understanding and remembering).
These symptoms have been described in different conditions that are mediated by the immune system (hence the name autoimmune and auto-inflammatory diseases) such as the Gulf war syndrome, macrophagic myofasciitis syndrome, post-vaccination phenomena, sarcoidosis, silicone implant incompatibility syndrome, Sjögren’s syndrome, and others. Some experts have studied the causes and correlation between those conditions and the exposure to an adjuvant (2), (3), (4).
Prevalence
The overall prevalence of ASIA syndrome is not well-defined because its clinical presentation differs across individuals, but it is rising in different countries (4). It is worth-noting that it is called ASIA because of the initials of the condition, not due to a geographical location.
Causes
ASIA syndrome can be induced by several elements, see figure 1.
Figure 1. Potential causes of ASIA syndrome [adapted from Cohen et. al (3)]
It is important to clarify that not all individuals who are exposed to adjuvants develop ASIA
syndrome. Moreover, some researchers have found that some individuals have a genetic predisposition to develop an exaggerated immune response triggered by the adjuvant (i.e., individuals with HLA DRB1 haplotypes) (3).
Diagnosis
The diagnosis involves physical examinations and tests to rule out other diseases that may be the cause of the symptoms that the individual experiences. Depending on the symptoms, the specialists involved in the diagnosis are rheumatologists, plastic surgeons, dermatologists and/or neurologists.
To receive a diagnose of ASIA syndrome, the individual must have at least two major criteria or one major criteria with two minor criteria, as shown in table 1 (5).
Table 1. Diagnostic criteria for ASIA syndrome [adapted from Seida et al (5)]
Major criteria | Minor criteria |
1. Exposure to an external stimulus (infection, vaccine, silicone, adjuvant) before the symptoms present. 2. The presence of “typical” clinical manifestations: · Muscle pain, swollen muscles, or muscle weakness. · Joint pain and/or arthritis · Chronic fatigue, sleep disruption, non-restorative sleep. · Neurological symptoms such as: numbness or tingling, vision problems, balance and coordination issues. · Cognitive impairment, memory loss. · Fever. 3. Typical findings in tissues after a biopsy of the affected organs. 4. Symptoms improve after the inciting agent is removed. | 1. Presence of antibodies (the body’s defenders) that target the suspected adjuvant. 2. Other clinical medical signs and symptoms (irritable bowel syndrome, interstitial cystitis, etc.). 3. Development or progression of an autoimmune disease. 4. Presence of specific molecules that are recognized by the leukocytes (defense cells) of the immune system as a potential threat). |
Treatment
Given the diversity in the clinical presentation of each case, the treatment for ASIA syndrome varies from patient to patient.
Sometimes the only available option is treating the symptoms individually with pain killers, steroids, and/or other corresponding measures, while autoimmune diseases may need modulators of the immune response.
In several cases, the removal of the triggering element (i.e. breast implants, fillers, meshes) was followed by the improvement of symptoms, so the explantation (removal) of the suspected element may become the treatment; nevertheless, not all patients benefit from it. The success of the explantation depends on many factors such as the implant characteristics, how long it was in the body, the disease and other variables (3).
It is note-worthy that not all patients with ASIA syndrome and an implant must have an explantation, because the symptoms might be caused by something else.
References
1. Watad A, Sharif K, Mediterr YS. The ASIA syndrome: basic concepts. Mediterranean Journal Of Rheumatology An Edition Of Greek Rheumatology Society And Professional Association Of Rheumatologists. J Rheumatol [Internet]. 2017 [cited 2024 Jul 8];28(2):64–73. Available from: http://www.mjrheum.org
2. Borba V, Malkova A, Basantsova N, Halpert G, Andreoli L, Tincani A, et al. Classical Examples of the Concept of the ASIA Syndrome. Biomolecules [Internet]. 2020 Oct 1 [cited 2024 Jul 8];10(10):1–17. Available from: /pmc/articles/PMC7600067/
3. Cohen Tervaert JW, Martinez-Lavin M, Jara LJ, Halpert G, Watad A, Amital H, et al. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) in 2023. Autoimmun Rev. 2023 May 1;22(5):103287.
4. Shoenfeld Y, Agmon-Levin N. ‘ASIA’ – Autoimmune/inflammatory syndrome induced by adjuvants. J Autoimmun. 2011 Feb 1;36(1):4–8.
5. Seida I, Alrais M, Seida R, Alwani A, Kiyak Z, Elsalti A, et al. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA): past, present, and future implications. Clin Exp Immunol [Internet]. 2023 [cited 2024 Jul 8];213:87–101. Available from: https://doi.org/10.1093/cei/uxad033
Assessed and Endorsed by the MedReport Medical Review Board
Comentários