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Available from: M. Cruz-Dominguez, Jan 11, 2016
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    ABSTRACT: 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.
    No preview · Article · Apr 2013 · Expert Review of Clinical Immunology
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    ABSTRACT: In this issue of IMAJ, the occurrence of a plethora of psychoneuro-immunological symptoms (also called ASIA or Shoenfeld syndrome) is described in three different patients. Segal and co-authors [1] present an 85 year old woman who underwent total hip replacement and experienced side effects. Patch testing showed hypersensitivity to cobalt and chromium. The metal components were replaced with ceramics and the symptoms disappeared. The second case, reported by Pineda and team [2], concerns a 53 year old woman with breast implants. Since silicone was found in her lymph nodes, removal of her implants was recommended. Finally, Cruz-Dominguez et al. [3] present the thought-provoking case of a patient exposed subcutaneously to a large amount of metallic mercury. The case illustrates that mercury might act as a potent adjuvant, inducing ASIA [4,5].
    Full-text · Article · Nov 2013 · The Israel Medical Association journal: IMAJ
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    ABSTRACT: In 2011 Shoenfeld and Agmon-Levin proposed a new syndrome as a way of grouping together a range of emerging autoimmune diseases with possible adjuvant-associated causes, Autoimmune/Auto-inflammatory Syndrome Induced by Adjuvants (ASIA). At present, there is no evidence to suggest that ASIA syndrome is a viable explanation for unusual autoimmune diseases. Since the initial paper, over 80 publications have discussed ASIA. This systematic review examines the research that has been done to investigate whether ASIA is a broad umbrella term with little clinical significance, or whether there is some underlying mechanism which could be utilised to reduce the occurrence of adjuvant mediated disease. Twenty-seven animal, epidemiological and case studies were reviewed. Unfortunately, a robust animal model of ASIA using biologically relevant doses of adjuvants has yet to be defined. It is also apparent that the broadness of the current ASIA criteria lack stringency and, as a result, very few cases of autoimmune disease could be excluded from a diagnosis of ASIA. The current studies involving human cases are so diverse, in both external stimuli and in resulting conditions, that there is currently a lack of reproducible evidence for any consistent relationship between adjuvant and autoimmune condition. The addition of a mandatory criterion requiring temporal association and clinically relevant adjuvant dose would allow better definition of what constitutes a diagnosis of ASIA. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Full-text · Article · Mar 2015 · Journal of Autoimmunity