Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) demonstrates distinct autoimmune and autoinflammatory disease associations according to the adjuvant subtype: Insights from an analysis of 500 cases

Clin Immunol. 2019 Jun;203:1-8. doi: 10.1016/j.clim.2019.03.007. Epub 2019 Mar 25.


Background: We investigated the pattern of reported immune diseases in the international ASIA syndrome registry.

Methods: Data from 500 subjects exposed to adjuvants from the ASIA syndrome international registry were analysed.

Results: The patient mean age was 43 ± 17 years and 89% were female. Within the reported immune diseases, 69% were well-defined immune diseases (autoimmune, autoinflammation, and mixed pattern diseases). Among the well-defined immune diseases following the exposure to adjuvants, polygenic autoimmune diseases were significantly higher than autoinflammatory disorders (92.7% vs 5.8%, respectively, p < 0.001). Polygenic autoimmune diseases such as connective tissue diseases were significantly linked to the exposure to HBV vaccine (OR 3.15 [95%CI 1.08-9.23], p = 0.036). Polygenic autoinflammatory diseases were significantly associated with the exposure to influenza vaccination (OR 10.98 [95%CI 3.81-31.67], p < 0.0001).

Conclusions: Immune conditions following vaccination are rare, and among these, polygenic autoimmune diseases represent the vast majority of the well-defined immune diseases reported under the umbrella ASIA syndrome. However, vaccines benefit outweighs their autoimmune side effects.

Keywords: ASIA syndrome; Foreign material; International syndrome registry; Silicone breast implants; Vaccines.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adjuvants, Immunologic
  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Autoimmune Diseases / epidemiology*
  • Child
  • Child, Preschool
  • Connective Tissue Diseases / epidemiology*
  • Female
  • Giant Cell Arteritis / epidemiology*
  • Hepatitis B Vaccines / immunology
  • Humans
  • Infant
  • Infant, Newborn
  • Inflammation / epidemiology*
  • Influenza Vaccines / immunology
  • Israel / epidemiology
  • Male
  • Middle Aged
  • Syndrome
  • Vaccination / statistics & numerical data*
  • Young Adult


  • Adjuvants, Immunologic
  • Hepatitis B Vaccines
  • Influenza Vaccines