Taking it all together, it seems that enigmatic but nevertheless common and often disabling complaints can coincide in many individuals diagnosed with siliconosis, MMF, GWS, or postvaccination events (see Table 1). Additionally, in up to 35% of these patients, autoimmunity (e.g., autoantibodies) or an overt autoimmune disease may eventually be diagnosed. A noteworthy common denominator is that the exposure to a component that comprises an adjuvant effect can be documented in each of those medical conditions. These phenomena can occur weeks and even or years following exposure to a culprit agent. Moreover, genetic links observed in animal models, and in the human disease MMF, bring about the notion that the adjuvant effect promotes the appearance of an adjuvant disease in subjects who are genetically susceptible or in those who encounter an additional trigger, such as the effect of another deleterious environmental factor (e.g., infectious agent) or co-exposure to more than one adjuvant.

Last but not least, these medical conditions were recently encompassed as ASIA. Looking back at the numerous reports in the last four or even five decades, one might ask if this is actually a new syndrome. Apparently, physicians have observed these phenomena for years, but the lack of definition remained a major obstacle in diagnosing, treating, and conducting basic as well as clinical studies.

Perhaps the most novel aspect of this new syndrome is its spacious view of these comparable diseases as well as improvement of their definition and diagnosis utilizing major and minor criteria (see Table 2). This innovative characterization may provide physicians a better way to understand to the immune consequences of environmental adjuvants and advance the diagnosis of patients suffering from the adjuvant diseases. Moreover, unraveling the adjuvant diseases pathogenesis may facilitate the search for preventive and therapeutic interventions such as immune modulation of the adjuvant pathways (e.g., TLRs , inflammasome, and others).

Dr. Shoenfeld is head of the Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center (affiliated with Tel-Aviv University), Tel-Hashomer, Israel. Dr. Levine is a senior physician in the Zabludowicz Center.


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  1. Hi..
    I had allergic reaction to a MRA which sent me to the Er.. I was diagnosed with aisa.. I had a injured vessel under my collarbone can the MRA have hurt my neck, shoulder, left upper chest.I have bubbles in my neck ..I’ve been in pain , burns, tingles, flares up..I feel inflamed..I have a slight buzzing which I never had before. . I’m concerned and scared.. when it flares in my neck it chokes me..hard to swallow. .intense vibrations in neck shoulder and I have a temp..

    • Hi. I have the same symptoms as you described, but in my case it may have been my breast implants. I have been looking for a proper diagnosis to my condition but after 14 doctors…none have ever mentioned ASIA … can you tell me how was the doctor that diagnose you with this condition?
      Thank you
      Mariel L.

      • Mariel Lizano google Breast Implant Illiness. Many woman are sick from having breast implants and have died from a result of them. There’s a support group on Facebook called breast implant illiness by Nicole where you can get a lot of helpful information. I was sick for 23 years with BII. I am still healing my body a year after explant but I am a lot better now.

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