Summary
Introduction
The syndrome autoimmune/inflammatory induced by adjuvants (ASIA) comprises a spectrum of clinical manifestations associated with exposure to different adjuvants, which have in common the generation of autoantibodies are not specific from the loss of immune tolerance.
Objective
The aim of the study was to conduct a narrative review of the literature on the pathogenesis that underlies the syndrome of ASIA, its differentiation from other autoimmune processes are defined, and the prospects for future research in this field.
Materials and methods
We made a narrative review of the literature in Pubmed, Embase, and LILACS, is included all types of publications in the subject, without time limit, in English and Spanish. Finally, we included 25 articles published since 1990, after which we review the pathogenesis, diagnostic criteria and differentiation from other autoimmune processes defined.
Results
The appearance of the syndrome of ASIA appears to be linked to a predisposition genetic individual (HLA-DRB1*01 or HLA-DRB4) and is the result of the interaction of external factors and endogenous trigger phenomena of autoimmunity. In recent years, doctors are more aware of the relationship between exposure to adjuvants, and the development of symptoms larvados in the time that may correspond to a syndrome of ASIA. The current evidence that supports its existence is still controversial. Timely diagnosis requires a multidisciplinary approach and may make it necessary to an immunosuppressive treatment in particular cases.
Conclusions
Exposure to adjuvants and their relationship with the occurrence of phenomena of autoimmunity has been recognized in recent years. In the clinical practice can be found cases of the syndrome of ASIA, despite the fact that the evidence supporting the relationship between adjuvants and clinical manifestations of autoimmune disorders is still debated. The qualifying criteria of the syndrome of ASIA require validation in diverse populations, before being applied in the selection of patients for clinical studies. It is necessary to identify the risk factors for the syndrome of ASIA, in order to better understand the pathophysiology and to make a timely diagnosis.
Abstract
Introduction
Adjuvant-induced autoimmune/inflammatory syndrome (ASIA) comprises a spectrum of clinical manifestations associated with exposure to diverse adjuvants that have in common the generation of non-specific autoantibodies and a loss of immune tolerance.
Objective
This study aimed to develop a narrative review of the literature about the pathogenesis underlying the ASIA syndrome, its differentiation from other defined autoimmune diseases, and prospects for future research in this field.
Materials and methods
A narrative review of the literature was conducted using Pubmed, Embase, and LILACS. All publications on the subject were included, with no time limit in English and Spanish. Finally, 25 articles published since 1990 were included, from which we reviewed the pathogenesis, diagnostic criteria, and its differentiation from other defined autoimmune processes.
Results
The appearance of the ASIA syndrome seems to be linked to an individual's genetic predisposition (HLA-DRB1*01 or HLA-DRB4) and is the result of the interaction of external and endogenous factors that trigger autoimmune phenomena. In recent years, physicians have become more aware of the relationship between exposure to adjuvants and the development of underlying signs and symptoms that may correspond to the ASIA syndrome. The current evidence supporting its existence is still contradictory. To timely diagnosis requires a multidisciplinary approach and could require immunosuppressive treatment in particular cases.
Conclusions
In recent years a relationship between exposure to adjuvants and the appearance of autoimmunity phenomena has been recognized. In clinical practice, physicians can find cases of ASIA syndrome. However, the evidence is still debated on the relationship between adjuvants and autoimmune clinical manifestations. ASIA syndrome classification criteria require validation in various populations before being applied to select patients for clinical studies. It is necessary to identify the risk factors for ASIA syndrome to understand sti pathophysiology and make a timely diagnosis.
Fragmentos de sección
Introduction
In the year 1964, Miyoshi et al. reported for the first time the possible complications of treatment with fillers, silicone and paraffin, included under the name of the disease adjuvant human (EHA). Between 2008 and 2012, Alijotas-Reig et al. they described a series of cases called "disease similar to the adjuvant human", to refer to the demonstrations triggered by bioimplantes different synthetic silicone and parafina1, 2.
In the year 2011, Shoenfeld and
Objective
Carry out a narrative review of the literature on the pathogenesis that underlies the syndrome of ASIA, its differentiation from other autoimmune processes are defined, and the prospects for future research in this field.
Literature search
We did a literature search in the databases PubMed, Embase, and LILACS, for which we used the MeSH terms "ASIA syndrome" AND "Silicone" AND "Review" between January and April of the year 2022.
There was No time limit for posts, since most of the studies come from cohort retrospective analyzed in deferred, and that the diagnostic criteria are proposed for the syndrome of ASIA have been changing with the time.
Population
We included studies with patients
Definition
ASIA comprises a set of clinical symptoms and signs that appear with a time variable-latency after exposure to an adjuvant (aluminum, squalene, pristano or silicone) that can meet or non-classification criteria that are defined for some immune-mediated disorders (lupus, rheumatoid arthritis, inflammatory myopathy, systemic sclerosis, vasculitis or sarcoidosis), or even fibromialgia3, 4.
The syndrome of miofascitis macrophagic is the infiltration of macrofágos and
Diagnosis
The syndrome of ASIA required for its diagnosis, the history of exposure to an adjuvant. There are special associations between adjuvants present in vaccines and manifestations compatible with the syndrome of ASIA, published mostly in series, and case reports:
- •Guillain-Barré syndrome (GBS) after influenza vaccines, or vaccines adenoviral vector against COVID-19. However, the risk is very low, its association is strongly controversial and insignificant with
Aid lab
The elevation of acute phase reactants and hypergammaglobulinemia, polyclonal, are the most common findings in the syndrome of ASIA in the first days or months of the disease. Anemia of chronic disease is a manifestation of late. It is important to apply paraclinical within the differential diagnosis, such as:
- •Thyroid-stimulating hormone (TSH): the primary hypothyroidism may present with fatigue, myalgias, and a box similar to the inflammatory myopathy.
- •Levels of
Treatment
Although there is lack of well-designed studies and management guidelines based on the evidence that demonstrate the positive effects of certain drugs in inflammatory disorders, local type panniculitis, related to the bioimplantes, its effectiveness has been reported in reports and case series. In addition to measures specific drug, it is recommended the cessation of smoking, as well as the correction of vitamin D deficiency, especially in patients with fatigue, arthralgia, and myalgia27
Conclusions
There is a relationship supported by experimental models (animal studies), descriptive (reports and case series) and observational studies (case-control) between exposure to adjuvants and symptoms associated with autoimmunity/self-ignition. Cohort studies, with an appropriate design and long-term follow up, do not support such an association, but in the clinical practice can be found cases of the syndrome of ASIA associated with silicone, mineral oils, squalene and
Ethical considerations
The current work complies with the regulations in force in research bioethics.
Funding
Did not receive any type of funding for the preparation of this article.
Conflict of interests
The authors declare that they have no conflicts of interest.
Acknowledgements
We thank Dr. Gloria Vasquez Duque, a professor in the program of Rheumatology, Faculty of Medicine, University of Antioquia.
Section snippets
Introduction
In 1964, Miyoshi et al. first reported the possible complications of treatment with silicone and paraffin fillers, classified under the name of human adjuvant disease (HAD). Between 2008 and 2012, Alijotas-Reig et al. described a series of cases that they called “human adjuvant-like disease” to refer to the manifestations triggered by synthetic bioimplants other than silicone and paraffin1, 2.
In 2011, Shoenfeld and
Aim
To conduct a narrative review of the literature on the pathogenesis underlying ASIA syndrome, its differentiation from other defined autoimmune processes, and the prospects for future research in this field.
Search For Literature
A bibliographic search was conducted in the PubMed, Embase and LILACS databases, using the MeSH terms “ASIA syndrome” AND “Silicone” AND “Review” between January and April 2022.
There was no time limit for publications, since most studies come from retrospective cohorts analyzed at a later time, and the diagnostic criteria proposed for ASIA syndrome have been modified over time.
Population
Studies with patients were included
Definition
ASIA comprises a set of clinical symptoms and signs that appear with a variable latency time after exposure to an adjuvant (aluminum, squalene, pristane or silicone), which may or may not meet classification criteria defined for some immune-mediated diseases (lupus, rheumatoid arthritis, inflammatory myopathies, systemic sclerosis, vasculitis or sarcoidosis), or even fibromyalgia3, 4.
Macrophagic myofasciitis syndrome is the infiltration of macrophages and
Diagnosis
For diagnosis, ASIA syndrome requires a history of exposure to an adjuvant. There are special associations between adjuvants present in vaccines and manifestations compatible with ASIA syndrome, published mainly in series and case reports:
- •Guillain-Barré syndrome (GBS) after influenza vaccines or adenoviral vector vaccines against COVID-19. However, the risk is very low, its association is strongly controversial and insignificant with
Laboratory Aids
Elevated acute phase reactants and polyclonal hypergammaglobulinemia are the most frequent findings in ASIA syndrome in the first days or months of the disease. Anemia of chronic disease is a late manifestation. It is important to request paraclinical tests within the differential diagnosis, such as:
- •Thyroid stimulating hormone (TSH): Primary hypothyroidism may present with fatigue, myalgia and a picture similar to inflammatory myopathy.
- •Levels of
Treatment
Although well-designed studies and evidence-based management guidelines demonstrating the positive effects of certain drugs on local inflammatory disorders such as panniculitis related to bioimplants are lacking, their efficacy has been reported in case reports and series. In addition to specific pharmacological measures, smoking cessation is recommended, as well as the correction of vitamin D deficiency, especially in patients with fatigue, arthralgia and myalgia 27
Conclusions
There is a relationship supported by experimental models (animal studies), descriptive models (case reports and series) and observational models (case-control studies) between exposure to adjuvants and symptoms related to autoimmunity/autoinflammation. Cohort studies, with an appropriate design and long-term follow-up, do not support this association, but in clinical practice cases of ASIA syndrome associated with silicone, mineral oils, squalene and other anti-inflammatory drugs can be found.
Written by Fabio Andres Torres-Saavedra, Lina Paola León-Sierra, Julian Rondon-Carvajal
2023/09/04
Original Source: https://www.sciencedirect.com/science/article/abs/pii/S012181232300083X
