ASIA Syndrome

Autoimmune/Inflammatory syndromes induced by adjuvants (ASIA) encompasses a cluster of related immune-mediated diseases, which develop among genetically prone individuals as a result to an adjuvant agent exposure. These conditions share several clinical aspects with the possible appearance of autoantibodies and of full-blown autoimmune diseases, trend to improve once the inciting agent is removed. According to a report on the international ASIA syndrome registry, the most frequent symptoms are fatigue, arthralgia, and myalgias. These individuals also exhibit a significant decline in their capacity to participate in activities they could engage in before their illness, including work, education, social interactions, and personal pursuits. In recent years, an increasing body of evidence in the medical literature has shed light on the ASIA syndrome, revealing novel aspects that enhance our understanding of this puzzling condition. Furthermore, additional elements are being proposed as part of new diagnostic criteria for ASIA, including dysregulated non-classical autoantibodies targeting coupled receptors of G protein of the autonomic nervous system and the presence of small fiber neuropathy. Regrettably, there have been no randomized clinical trials conducted to address the management of ASIA, and there is a lack of established guidelines. Nevertheless, drawing from our own clinical experiences, several therapeutic considerations can be proposed.