Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome): clinical and immunological spectrum

Expert Rev Clin Immunol. 2013 Apr;9(4):361-73. doi: 10.1586/eci.13.2.


An adjuvant is a substance that enhances the antigen-specific immune response, induces the release of inflammatory cytokines, and interacts with Toll-like receptors and the NALP3 inflammasome. The immunological consequence of these actions is to stimulate the innate and adaptive immune response. The activation of the immune system by adjuvants, a desirable effect, could trigger manifestations of autoimmunity or autoimmune disease. Recently, a new syndrome was introduced, autoimmune/inflammatory syndrome induced by adjuvants (ASIA), that includes postvaccination phenomena, macrophagic myofasciitis, Gulf War syndrome and siliconosis. This syndrome is characterized by nonspecific and specific manifestations of autoimmune disease. The main substances associated with ASIA are squalene (Gulf War syndrome), aluminum hydroxide (postvaccination phenomena, macrophagic myofasciitis) and silicone with siliconosis. Mineral oil, guaiacol and iodine gadital are also associated with ASIA. The following review describes the wide clinical spectrum and pathogenesis of ASIA including defined autoimmune diseases and nonspecific autoimmune manifestations, as well as the outlook of future research in this field.

Publication types

  • Review

MeSH terms

  • Adaptive Immunity
  • Adjuvants, Immunologic / administration & dosage
  • Adjuvants, Immunologic / adverse effects*
  • Aluminum Hydroxide / administration & dosage
  • Aluminum Hydroxide / adverse effects
  • Animals
  • Autoimmune Diseases / chemically induced
  • Autoimmune Diseases / immunology*
  • Fasciitis / chemically induced
  • Fasciitis / immunology*
  • Humans
  • Immunity, Innate
  • Inflammasomes / metabolism
  • Inflammation / chemically induced
  • Inflammation / immunology*
  • Myositis / chemically induced
  • Myositis / immunology*
  • Persian Gulf Syndrome / chemically induced
  • Persian Gulf Syndrome / immunology*
  • Silicones / administration & dosage
  • Silicones / adverse effects
  • Silicosis / immunology*
  • Squalene / administration & dosage
  • Squalene / adverse effects
  • Syndrome
  • Toll-Like Receptors / metabolism


  • Adjuvants, Immunologic
  • Inflammasomes
  • Silicones
  • Toll-Like Receptors
  • Aluminum Hydroxide
  • Squalene

Supplementary concepts

  • Macrophagic myofasciitis