ASIA stands for A utoimmune/inflammatory S yndrome I nduced by A djuvants. This is a controversial concept suggesting that certain environmental exposures (infections, vaccines, adjuvants, silicone, and drugs) can act as an adjuvant stimulating the innate immune system, resulting in symptoms and/or subsequent stimulation of the adaptive immune system leading to autoantibodies and/or an autoimmune disease. In patients who already have a defined autoimmune disease, these adjuvants may exacerbate their disease. Because this only occurs in a small fraction of patients exposed to these adjuvants, causality is difficult to prove.
The proposed diagnostic criteria are: (1) development of symptoms (muscle, joint, fatigue, demyelination, cognitive impairment, pyrexia) or (2) development of an undifferentiated CTD and/or autoantibodies within proximity to exposure to an adjuvant. Some examples are:
- • Immunizations: associated with causing demyelinating syndromes, reactive arthritis, and small vessel vasculitis. Recombinant hepatitis B vaccination has been associated with a higher than expected number of rheumatic disorders including vasculitis (especially central retinal vein occlusion), RA, SLE, reactive arthritis, as well as various demyelination syndromes. These rheumatic disorders occur within 1 to 2 months of the first, second, or third vaccination. Unlike other typical side effects of an immunization, these rheumatic disorders may not resolve.
- • Silicone: breast implants (especially those that ruptured) and oil injections for cosmetic purposes have been reported to cause scleroderma-like diseases. Very controversial.
- • Alum adjuvant: aluminum in vaccines has been associated with causing the macrophage myofasciitis syndrome.
- • Gulf War syndrome: soldiers exposed to multiple vaccinations in a short period of time developed fibromyalgia-like symptoms and cognitive dysfunction. All patients had antisqualene antibodies.
- • Case reports of parvovirus infection with arthritis evolving into RA, EBV infection evolving into SLE, and procainamide exposure triggering SLE that does not resolve with drug withdrawal.