What is ASIA syndrome?

The ASIA syndrome or adjuvant-induced autoimmune / autoinflammatory syndrome results from an immune response to foreign substances. We explain it to you.

Written and verified by the doctor Mariel mendoza on October 17, 2021.

Last update: October 17, 2021

The concept of ASIA syndrome comes from an acronym in English. Refers to adjuvant-induced autoimmune / autoinflammatory syndrome and it is a rare entity in which a reaction occurs towards a foreign substance to the body.

By definition, the word adjuvant refers to a substance capable of increasing the activity of the immune system against an antigen, without directly eliciting a response. In some cases, adjuvants contain components of microbes that stimulate the immune response.

Initially described by Shoenfeld and Agmon-Levin in 2011, which is why it is also known as Shoenfeld syndrome, ASIA is a set of signs and symptoms resulting from an exaggerated immune response to adjuvants. The time in which symptoms appear can vary from hours to years.

Silicone is one of the adjuvants of ASIA syndrome

Silicone is a colorless, odorless polymer that is primarily made up of silicon. In medicine it is used for the manufacture of joint, breast, or tendon implants. It is also used for heart valve prostheses, intraocular lenses and in cosmetic procedures.

There is no specific work linking rheumatic or autoimmune diseases with silicone. In fact, the United States Food and Drug Administration (FDA) approves its medical use.

However, although it was previously considered inert, it is capable of generating a response. Disorders of the immune system have been described since 1965 associated with breast implants. Their relationship is rare, but in some cases there may be nonspecific clinical manifestations, such as chronic fatigue, joint and muscle pain, alopecia, paresthesia, and fever.

These manifestations are included within the so-called siliconosis, which is one of the first diseases recognized as being induced by adjuvants. There are also local adverse effects, such as the generation of granulomas around the silicone (siliconoma).

The reaction to silicone in breast prostheses is one of the most recognized within the ASIA syndrome.

Symptoms and diagnosis of ASIA syndrome

The symptoms are very varied and nonspecific in this condition. They include muscle pain, inflammation and weakness, joint inflammation, chronic fatigue, and sleep disturbances. Memory loss, fever and dry eye may also appear. Locally, at the site of administration of the adjuvant, edema and nodules and swelling of the adjacent nodes may appear.

There is no specific laboratory test for its diagnosis. In certain cases there may be autoantibodies towards the adjuvant or inflammatory markers, but they are not specific.

Although there are no specific risk factors, if you have a personal or family history of autoimmune diseases it is recommended to go to a rheumatology specialist prior to the placement of adjuvants.

Diagnostic criteria

The diagnosis of the syndrome is through the clinical criteria proposed by Shoenfeld and Agmon-Levin in 2011. The clinical manifestations and personal history are the main basis.

The presence of 2 major criteria is required or 1 major criterion and 2 minor criteria to make the diagnosis of ASIA syndrome.

The major criteria are the following:

  • Exposure to an external stimulus (infection, vaccine, silicone, adjuvant).
  • Appearance of typical clinical manifestations: Muscle weakness or inflammation, joint pain, chronic fatigue, unrefreshing sleep, cognitive disturbances, memory loss, fever, dry eye.
  • Triggering agent removal leads to improvement.
  • Biopsy: with typical changes of the involved organs.

On the other hand, the minor criteria are the following:

  • Appearance of autoantibodies or antibodies directed to the adjuvant involved.
  • Other clinical manifestations: like irritable bowel syndrome.
  • Specific human leukocyte antigens: HLA DRB1, HLA DQB1.
  • Evolution to some autoimmune disease: multiple sclerosis or systemic sclerosis.

Treatment and prognosis

The main treatment is total surgical removal of the adjuvant. For example, the removal of silicone implants. In these cases, the response is usually favorable and immediate.

However, when there is local or systemic migration of the substance, with the consequent general affectation of the organism, it is necessary to initiate an approach with immunomodulatory drugs. This lowers the response of the immune system.

Long-term prognosis is difficult to establish, since it will depend on the associated diseases in the person who suffers from it. It is recommended to see a specialist in rheumatology prior to the placement of an adjuvant in case of personal or family history, to assess the relationship between risk and benefit.

People with a family or personal history of previous reactions should make a rheumatology consultation.

Differential diagnosis for ASIA syndrome

ASIA syndrome is not very common. Today, scientific evaluations prior to implant approval are increasingly rigorous.

However, the symptoms are not specific and are common with other pathologies, so that the clinical criteria could classify an autoimmune disease or a collagen disorder (such as systemic lupus erythematosus) by mistake.

Specific diagnosis is cumbersome and is considered exclusionary. This is why the multidisciplinary action of plastic surgeons, rheumatologists and psychiatrists is necessary, if necessary.

We must raise awareness about the risk involved in various cosmetic treatments, especially in people who are predisposed to autoimmune diseases. Specialized advice is key.

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