Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA): Insights into Pathogenesis, Diagnosis, and Management

Luis Jesuino de Oliveira Andrade; Gabriela Correia Matos de Oliveira; Luís Matos de Oliveira; Luanna Lopes da Silva Ramos; Osmario Jorge de Mattos Salles

doi:10.1590/SciELOPreprints.14296

##article.authors##

Luis Jesuino de Oliveira Andrade State University of Santa Cruz https://orcid.org/0000-0002-7714-0330
- Conceptualization
- Formal Analysis
- Investigation
- Methodology
- Supervision
- Validation
- Visualization
- Writing – Original Draft Preparation
- Writing – Review & Editing
- Data Curation
Gabriela Correia Matos de Oliveira José Silveira Foundation, Salvador, Bahia, Brazil. https://orcid.org/0000-0002-8042-0261
- Data Curation
- Formal Analysis
- Investigation
- Methodology
- Supervision
- Validation
- Visualization
- Writing – Original Draft Preparation
Luís Matos de Oliveira State University of Santa Cruz https://orcid.org/0000-0003-4854-6910
- Data Curation
- Formal Analysis
- Investigation
- Methodology
- Supervision
- Validation
- Visualization
- Writing – Original Draft Preparation
- Writing – Review & Editing
Luanna Lopes da Silva Ramos Universidade Salvador https://orcid.org/0009-0002-1499-562X
- Data Curation
- Formal Analysis
- Investigation
- Validation
- Visualization
Osmario Jorge de Mattos Salles Bahian School of Medicine and Public Health https://orcid.org/0009-0002-1859-0478
- Conceptualization
- Data Curation
- Formal Analysis
- Investigation
- Methodology
- Supervision
- Validation
- Visualization
- Writing – Original Draft Preparation
- Writing – Review & Editing

DOI:

https://doi.org/10.1590/SciELOPreprints.14296

Keywords:

Autoimmune syndrome, Shoenfeld syndrome, Vaccine safety, Silicone implants

Abstract

Background: Autoimmune/Inflammatory Syndrome Induced by Adjuvants (ASIA) represents a unified conceptual framework proposed in 2011 to encompass diverse immune-mediated disorders triggered by adjuvant exposure in genetically predisposed individuals. Objective: This review aims to synthesize the current understanding of ASIA's pathogenesis, clinical manifestations, diagnostic approaches, and therapeutic strategies, while identifying critical gaps in existing research. Methods: A comprehensive narrative synthesis was conducted, examining literature from multiple databases (PubMed/MEDLINE, Scopus, Web of Science, Embase) for publications spanning from 2011 through 2025. Data were synthesized across four domains: immunopathogenic mechanisms, clinical phenotypes, evolution of diagnostic criteria, and emerging adjuvant substances. Results: The pathophysiology of ASIA syndrome is complex, involving innate immune activation, a breakdown of self-tolerance, and chronic inflammation. Primary triggers include aluminum-based vaccine adjuvants, silicone implants, and other biomaterials. Clinically, the syndrome manifests with significant heterogeneity, encompassing constitutional symptoms, musculoskeletal involvement, and multiorgan system pathology. Current diagnostic criteria require further refinement, and therapeutic management primarily emphasizes the removal of the inciting adjuvant and subsequent immunomodulation. Controversial aspects persist, including debates regarding its nosological validity, implications for vaccine safety, and medico-legal dimensions. Conclusion: Despite ongoing scientific debate, ASIA represents a valuable framework for understanding the link between adjuvant exposure and autoimmune phenomena. Future research must prioritize prospective cohort studies, advanced immunophenotyping, standardized diagnostic protocols, and the development of safer adjuvants to optimize patient care without compromising public health initiatives.