Autoimmune/inflammatory syndrome induced by adjuvants

Autoimmune/inflammatory syndrome induced by adjuvants (ASIA), or Shoenfeld's syndrome, is a hypothesised autoimmune disorder proposed by Israeli immunologist Yehuda Shoenfeld in 2011.^[1] According to Shoenfeld, the syndrome is triggered by exposure to adjuvants and includes four conditions: "post-vaccination symptoms", macrophagic myofasciitis, Gulf war syndrome, sick building syndrome, and siliconosis.^[2][3] Shoenfeld has also named Sjögren's syndrome as potentially being another facet of ASIA.^[4] ASIA as an umbrella term has also been said to include: multiple chemical sensitivity, repetition stress injury, chronic fatigue syndrome/ myalgic encephalomyelitis, complex regional pain syndrome, and postural and orthostatic tachycardia syndrome.^[5]

Apart from the theoretical concept of ASIA, there no evidence for any causal relationship between adjuvant and autoimmune condition.^[6] A study of 18,000 people showed that there is no merit to the theory of autoimmune/inflammatory syndrome induced by adjuvants.^[7]

Shoenfeld alleges that the syndrome is caused by adjuvants such as silicone, tetramethylpentadecane, pristane, and aluminum.^[8] However, causality is difficult to prove because ASIA only occurs in a small fraction of patients exposed to these adjuvants.^[9] Additionally, proponents of this theory allege that the disorder can manifest anywhere from 2 days to 23 years after exposure.^[3]