Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) 2013: Unveiling the pathogenic, clinical and diagnostic aspects

J Autoimmun. 2013 Dec:47:1-16. doi: 10.1016/j.jaut.2013.10.004. Epub 2013 Nov 13.


In 2011 a new syndrome termed 'ASIA Autoimmune/Inflammatory Syndrome Induced by Adjuvants' was defined pointing to summarize for the first time the spectrum of immune-mediated diseases triggered by an adjuvant stimulus such as chronic exposure to silicone, tetramethylpentadecane, pristane, aluminum and other adjuvants, as well as infectious components, that also may have an adjuvant effect. All these environmental factors have been found to induce autoimmunity by themselves both in animal models and in humans: for instance, silicone was associated with siliconosis, aluminum hydroxide with post-vaccination phenomena and macrophagic myofasciitis syndrome. Several mechanisms have been hypothesized to be involved in the onset of adjuvant-induced autoimmunity; a genetic favorable background plays a key role in the appearance on such vaccine-related diseases and also justifies the rarity of these phenomena. This paper will focus on protean facets which are part of ASIA, focusing on the roles and mechanisms of action of different adjuvants which lead to the autoimmune/inflammatory response. The data herein illustrate the critical role of environmental factors in the induction of autoimmunity. Indeed, it is the interplay of genetic susceptibility and environment that is the major player for the initiation of breach of tolerance.

Keywords: Adjuvant; Autoantibodies; Autoimmune/Inflammatory syndrome induced by adjuvants; Autoimmunity; Saccharomyces cerevisiae; Vaccine.

Publication types

  • Review

MeSH terms

  • Adjuvants, Immunologic / adverse effects*
  • Aluminum / adverse effects
  • Autoantibodies / biosynthesis
  • Autoantibodies / immunology*
  • Autoimmune Diseases / diagnosis*
  • Autoimmune Diseases / immunology*
  • Fasciitis / immunology
  • Humans
  • Inflammation / diagnosis*
  • Inflammation / immunology*
  • Myositis / immunology
  • Persian Gulf Syndrome / immunology
  • Sick Building Syndrome / immunology
  • Silicones / adverse effects
  • Silicosis / immunology
  • Syndrome
  • Terpenes / adverse effects
  • Vaccines / immunology


  • Adjuvants, Immunologic
  • Autoantibodies
  • Silicones
  • Terpenes
  • Vaccines
  • pristane
  • Aluminum

Supplementary concepts

  • Macrophagic myofasciitis