ASIA

Acronym for "autoimmune syndrome induced by adjuvant" (see also Autoinflammatory syndromes).

In adults, these adverse drug reactions(ADRs ) primarily relate to the influenza vaccination, less frequently to vaccination with a COVId-19 vaccine. They are also referred to as AEFI (adverse events following immunization). A separate form of these acquired autoimmunological syndromes was also referred to as"Gulf war syndrome".

To assess a suspected ADR, WHO criteria are usually used, which vary between:

• certain
• probable/likely
• possible
• unlikely
• incomplete (conditional/unclassified) and
• unassessable (unassessable/unclassifiable)

can be distinguished.

Clinically, the following symptoms are observed in ASIA: recurrent fever, myalgias, arthralgias, cognitive disorders, gastrointestinal and respiratory syndromes, exanthema (see case report below) and the (unspecific) occurrence of various autoantibodies. Bullous pemphigoid and autoimmune hemolytic anemia have been described associatively. It is possible that "Breast Implant-Associated Immunological Disorders" belong to this group of diseases (Suh LJ et al. 2022).

A 73-year-old male patient presented with disseminated, erythematous, pruritic and pressure-dolent, nodular efflorescences on the entire integument, which correlated histologically with perivascular, interstitial dermatitis and discrete septal panniculitis. These occurred for the first time a year ago immediately after an influenza vaccination. Furthermore, there were recurrent episodes of fever and myalgia with increasing muscle weakness, weight loss and fatigue.

Laboratory chemistry revealed autoimmune hemolytic anemia (direct Coombs test positive, haptoglobin strongly elevated), pronounced leukopenia and elevated acute phase parameters such as CRP, ESR and ferritin. The blood smear and bone marrow biopsy showed evidence of drug-related toxic damage. Both lymphoproliferative and rheumatic diseases were largely ruled out. The diagnosis of ASIA could be made in the presence of 3 major criteria (myalgia, fatigue, fever) and the medical history (previous vaccination). Treatment with oral glucocorticosteroids was initiated, which resulted in a dramatic improvement of the symptoms.

Discussion: The present case of an ASIA illustrates that complex, highly chronic autoimmunologic/inflammatory clinical pictures can occur after "banal" vaccination. In addition, cutaneous and hematologic symptoms also appear to lie within the spectrum of ASIA.

1. Hehn J et al. (2003) Influenza vaccination and dermatoses- coincidence or causal association. JDDG 2: 99-104

2. Israeli E (2012) Gulf War syndrome as a part of the autoimmune (autoinflammatory) syndrome induced by adjuvant (ASIA). Lupus 21:190194.
3. Moreno-Urbina SI et al. (2023) Síndrome autoinmunitario/inflamatorio inducido por adyuvantes. Reporte de caso. Rev Med Inst Mex Seguro Soc 61:251-255.
4. Rajchenberg D et al. (2024) Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) from 2011 to 2024: A comprehensive bibliometric review. Autoimmun Rev 23:103676.

5. Suh LJ et al. (2022) Breast Implant-Associated Immunological Disorders. J Immunol Res 2022:8536149.