ASIA Syndrome in the Research Literature

The following abstracts are from important medical journal articles that represent a very small percentage of all the articles that have been authored by groups of (courageous) non-indoctrinated researchers who have been looking into the important issue of the taboo subject of (because of its iatrogenicity) adjuvant-induced autoimmune disorders.

 I have mostly positioned the dozen or so abstracts below in the order of their publication (except for the first one) although the most important abstracts may be at the end of this column.

 These pre-2018 authors are among the few researchers that did not have financial or professional conflicts of interest with any of the following entities:

1) pro-vaccine, for-profit Big Pharma or Big Vaccine corporations;

2) pro-vaccine establishment educational/research institutions (including medical schools, large hospitals and large clinics/HMOs);

3) pro-vaccine regulatory agencies (such as the CDC, the FDA, the NIH, etc); 

4) pro-vaccine medical professional medical lobbying groups (including the AMA, AAP, AAFP, etc);

5) any pro-vaccine, for-profit investment or Wall Street-type entity; or any

6) pro-vaccine wealthy funding entity like the Bill & Melinda Gates Foundation.


 Could Autoimmunity be Induced by Vaccination?

 Salemi S1, D'Amelio R

 Author information

 Int Rev Immunol. 2010 Jun;29(3):247-69. doi: 10.3109/08830181003746304


Autoimmune reactions to vaccinations may rarely be induced in predisposed individuals by molecular mimicry or bystander activation mechanisms. Autoimmune reactions reliably considered vaccine-associated, include Guillain-Barré syndrome after 1976 swine influenza vaccine, immune thrombocytopenic purpura after measles/mumps/rubella vaccine, and myopericarditis after smallpox vaccination, whereas the suspected association between hepatitis B vaccine and multiple sclerosis has not been further confirmed, even though it has been recently reconsidered, and the one between childhood immunization and type 1 diabetes seems by now to be definitively gone down. Larger epidemiological studies are needed to obtain more reliable data in most suggested associations.



 J Autoimmun. 2000 Feb;14(1):1-10

 Vaccination and autoimmunity-'vaccinosis': a dangerous liaison?

Shoenfeld Y1, Aron-Maor A

 Author information


The question of a connection between vaccination and autoimmune illness (or phenomena) is surrounded by controversy. A heated debate is going on regarding the causality between vaccines, such as measles and anti-hepatitis B virus (HBV), and multiple sclerosis (MS).

Anti-brain tissue antibodies as well as clinical central nervous system symptoms have been found in patients vaccinated against those diseases.

Other autoimmune illnesses have been associated with vaccinations. Tetanus toxoid, influenza vaccines, polio vaccine, and others, have been related to phenomena ranging from autoantibodies production to full-blown illness (such as rheumatoid arthritis (RA)). Conflicting data exists regarding also the connection between autism and vaccination with measles vaccine. So far only one controlled study of an experimental animal model has been published, in which the possible causal relation between vaccines and autoimmune findings has been examined: in healthy puppies immunized with a variety of commonly given vaccines, a variety of autoantibodies have been documented but no frank autoimmune illness was recorded. The findings could also represent a polyclonal activation (adjuvant reaction).

The mechanism (or mechanisms) of autoimmune reactions following immunization has not yet been elucidated. One of the possibilities is molecular mimicry; when a structural similarity exists between some viral antigen (or other component of the vaccine) and a self-antigen. This similarity may be the trigger to the autoimmune reaction.

Other possible mechanisms are discussed. Even though the data regarding the relation between vaccination and autoimmune disease is conflicting, it seems that some autoimmune phenomena are clearly related to immunization (e.g. Guillain-Barre syndrome). The issue of the risk of vaccination remains a philosophical one, since to date the advantages of this policy have not been refuted, while the risk for autoimmune disease has not been irrevocably proved. We discuss the pros and cons of this issue (although the temporal relationship (i.e. always 2-3 months following immunization) is impressive).


 Lupus. 2009 Nov;18(13):1186-91. doi: 10.1177/0961203309346975

 Vaccination of healthy subjects and autoantibodies: from mice through dogs to humans

 Toplak N1, Avcin T

 Author information


Vaccination against pathogenic microorganisms is one of the major achievements of modern medicine, but due to an increasing number of reports of adverse reactions the vaccination procedure has induced also considerable debate. It is well known that certain infections are involved in triggering the production of autoantibodies, which could lead to autoimmune adverse reactions in genetically predisposed subjects. Based on these findings it was assumed that vaccinations might induce similar autoimmune reactions.

At present there is no clear-cut evidence that vaccinations are associated with overt autoimmune diseases but it has been demonstrated that in genetically predisposed persons vaccination can trigger the production of autoantibodies and autoimmune adverse reactions. The first studies investigating the production of autoantibodies following vaccination were done in dogs and mice. Several studies investigated the production of autoantibodies following vaccination in patients with autoimmune diseases, but there are only limited data on the autoimmune responses after vaccinations in apparently healthy humans. This review summarizes current evidence on the vaccination-induced autoantibodies in apparently healthy subjects including studies in animals and humans.


Clin Rev Allergy Immunol. 2011 Oct;41(2):163-8. doi: 10.1007/s12016-010-8212-4

 Macrophagic myofasciitis a vaccine (alum adjuvant-containing) autoimmune-related disease

 Israeli E1, Agmon-Levin NBlank MShoenfeld Y

 Author information


Macrophagic myofasciitis (MMF) is an immune-mediated condition first reported in 1998. MMF is characterized by post-vaccination systemic manifestations as well as local-stereotyped and immunologically active lesion in the site of inoculation (deltoid muscle). MMF systemic symptoms included myalgias, arthralgias, marked asthenia, muscle weakness, chronic fatigue, and fever. Recently, studies demonstrated that the local lesion is due to persistence for years at site of injection of an aluminum (Al(OH)3) adjuvant commonly used in human vaccines. Time elapsed from last immunization with an Al(OH)3-containing vaccine to muscle biopsy range from 3 months to 8 years; in rare cases, MMF may be diagnosed even 10 years post-vaccination. The discrepancy between the wide applications of aluminum hydroxide-containing vaccines and the very limited number of MMF cases reported may be resolved by observations suggesting that aluminum-containing vaccinations may trigger MMF in genetically susceptible subjects carrying the HLA-DRB1*01. Thus, MMF may be defined as an emerging novel condition that may be triggered by exposure to alum-containing vaccines, in patients with a specific genetic background, and this temporal association may be exhibited from a few months up to 10 years.


 Lupus. 2012 Feb;21(2):128-35. doi: 10.1177/0961203311429317

 Human adjuvant disease induced by foreign substances: a new model of ASIA (Shoenfeld's syndrome)

 Vera-Lastra O1, Medina GCruz-Dominguez Mdel PRamirez PGayosso-Rivera JAAnduaga-Dominguez HLievana-Torres CJara LJ

 Author information



To investigate the clinical, laboratory and histological manifestations of patients who received illegal injections of foreign substances for cosmetic purposes.


We studied patients who met the following inclusion criteria: 1) history of application of foreign substances for cosmetic purposes, 2) clinical data of autoimmune disease or non-specific autoimmune manifestation (i.e. arthralgias, myalgia, malaise, fever, and weight loss), 3) detection of autoantibodies in patients' sera, 4) histological evidence of chronic inflammation and/or granulomatous reaction to foreign body.


Fifty female patients aged 44.4 ± 10 years were studied. The mean time between application of foreign substances and onset of symptoms was 4.5 ± 4.3 years. Patients were followed for 12 ± 7.5 years. Forty-one patients were injected with mineral oil, nine patients received other substances: three iodine gadital, one guayacol, one guayacol plus silicone fluid, two collagen, two silicone fluid. The sites of application were: buttocks (36), legs and/or thighs (11), breasts (eight) hands and face (one), face (two) (seven patients received an injection to more than one site).

30 patients presented with non-specific autoimmune manifestations, whereas 20 patients fulfilled the criteria for a defined autoimmune disease such as systemic lupus erythematosus, rheumatoid arthritis, systemic sclerosis, overlap syndrome, autoimmune hemolytic anemia, autoimmune thyroiditis, autoimmune hepatitis, and ulcerative colitis.


Cases of human adjuvant disease following illegal injections of oil substances for cosmetic purposes are reported. Patients presented with defined autoimmune diseases as well as with non-specific autoimmune manifestations. Illegal injection of these substances could lead to serious local and systemic complications, even to death. These cases represent another model of Autoimmune/inflammatory Syndrome Induced by Adjuvants (ASIA). The use of these substances should be prohibited.


 Lupus. 2012 Feb;21(2):146-52. doi: 10.1177/0961203311429318

 Autoimmunity following hepatitis B vaccine as part of the spectrum of 'Autoimmune (Auto-inflammatory) Syndrome induced by Adjuvants' (ASIA): analysis of 93 cases

 Zafrir Y1, Agmon-Levin NPaz ZShilton TShoenfeld Y

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In this study we analyzed the clinical and demographic manifestations among patients diagnosed with immune/autoimmune-mediated diseases post-hepatitis B vaccination. We aimed to find common denominators for all patients, regardless of different diagnosed diseases, as well as the correlation to the criteria of Autoimmune (Auto-inflammatory) Syndrome induced by Adjuvants (ASIA).


We have retrospectively analyzed the medical records of 114 patients, from different centers in the USA, diagnosed with immune-mediated diseases following immunization with hepatitis-B vaccine (HBVv). All patients in this cohort sought legal consultation. Of these, 93/114 patients diagnosed with disease before applying for legal consultation were included in the study. All medical records were evaluated for demographics, medical history, number of vaccine doses, peri-immunization adverse events and clinical manifestations of diseases. In addition, available blood tests, imaging results, treatments and outcomes were recorded. Signs and symptoms of the different immune-mediated diseases were grouped according to the organ or system involved. ASIA criteria were applied to all patients.


The mean age of 93 patients was 26.5 ± 15 years; 69.2% were female and 21% were considered autoimmune susceptible. The mean latency period from the last dose of HBVv and onset of symptoms was 43.2 days. Of note, 47% of patients continued with the immunization program despite experiencing adverse events. Manifestations that were commonly reported included neuro-psychiatric (70%), fatigue (42%) mucocutaneous (30%), musculoskeletal (59%) and gastrointestinal (50%) complaints. Elevated titers of autoantibodies were documented in 80% of sera tested. In this cohort 80/93 patients (86%), comprising 57/59 (96%) adults and 23/34 (68%) children, fulfilled the required criteria for ASIA.


Common clinical characteristics were observed among 93 patients diagnosed with immune-mediated conditions post-HBVv, suggesting a common denominator in these diseases. In addition, risk factors such as history of autoimmune diseases and the appearance of adverse event(s) during immunization may serve to predict the risk of post-immunization diseases. The ASIA criteria were found to be very useful among adults with post-vaccination events. The application of the ASIA criteria to pediatric populations requires further study.


 Immunol Res. 2013 Jul;56(2-3):299-303. doi: 10.1007/s12026-013-8400-4

 Adverse events following immunization with vaccines containing adjuvants

 Cerpa-Cruz S1, Paredes-Casillas PLanderos Navarro EBernard-Medina AGMartínez-Bonilla GGutiérrez-Ureña S

 Author information


A traditional infectious disease vaccine is a preparation of live attenuated, inactivated or killed pathogen that stimulates immunity. Vaccine immunologic adjuvants are compounds incorporated into vaccines to enhance immunogenicity. Adjuvants have recently been implicated in a new syndrome named ASIA (autoimmune/inflammatory syndrome induced by adjuvants).

The objective describes the frequencies of post-vaccination clinical syndrome induced by adjuvants. We performed a cross-sectional study; adverse event following immunization was defined as any untoward medical occurrence that follows immunization 54 days prior to the event. Data on vaccinations and other risk factors were obtained from daily epidemiologic surveillance. Descriptive statistics were done using means and standard deviation, and odds ratio adjusted for potential confounding variables was calculated with SPSS 17 software.

43 out of 120 patients with moderate or severe manifestations following immunization were hospitalized from 2008 to 2011. All patients fulfilled at least 2 major and 1 minor criteria suggested by Shoenfeld and Agmon-Levin for ASIA diagnosis. The most frequent clinical findings were pyrexia 68%, arthralgias 47%, cutaneous disorders 33%, muscle weakness 16% and myalgias 14%. Three patients had diagnosis of Guillain-Barre syndrome, one patient had Adult-Still's disease 3 days after vaccination. A total of 76% of the events occurred in the first 3 days post-vaccination. Two patients with previous autoimmune disease showed severe adverse reactions with the reactivation of their illness. Minor local reactions were present in 49% of patients.

Vaccines containing adjuvants may be associated with an increased risk of autoimmune/inflammatory adverse events following immunization.


Sci Rep. 2016 Nov 11;6:36943. doi: 10.1038/srep36943

Murine hypothalamic destruction with vascular cell apoptosis subsequent to combined administration of human papilloma virus (HPV) vaccine and pertussis toxin

 Aratani S1,2,3, Fujita H1,2, Kuroiwa Y4, Usui C5, Yokota S1, Nakamura I6, Nishioka K1, Nakajima T1,2,7

 Author information


Vaccination is the most powerful way to prevent human beings from contracting infectious diseases including viruses. In the case of the human papillomavirus (HPV) vaccine, an unexpectedly novel disease entity, HPV Vaccination Associated Neuro-immunopathetic Syndrome (HANS), has been reported and remains to be carefully verified. To elucidate the mechanism of HANS, we applied a strategy similar to the active Experimental Autoimmune Encephalitis (EAE) model - one of the most popular animal models used to induce maximum immunological change in the central nervous system. Surprisingly, mice vaccinated with pertussis toxin showed neurological phenotypes that include low responsiveness of the tail reflex and locomotive mobility.

Pathological analyses revealed the damage to the hypothalamus and circumventricular regions around the third ventricle, and these regions contained apoptotic vascular endothelial cells. These data suggested that HPV-vaccinated doners that are susceptible to the HPV vaccine might develop HANS under certain environmental factors. These results will give us the new insight into the murine pathological model of HANS and help us to find a way to treat of patients suffering from HANS.



 Immunol Res. 2016 Jul 13

 Severe manifestations of Autoimmune Syndrome Induced by Adjuvants (Shoenfeld's syndrome)

 Jara LJ1,2, García-Collinot G3, Medina G4,5, Cruz-Dominguez MD3,5, Vera-Lastra O6,5, Carranza-Muleiro RA3, Saavedra MA7,5

 Author information


Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) encompassing conditions linked to previous exposure to an adjuvant substance. The clinical picture is very heterogeneous, from mild to severe manifestations, including death. However, the systematic analysis of severe ASIA cases has not been performed. The aim of this study was to systematically review the literature on severe ASIA cases. A systematic review of the literature was performed investigating severe ASIA cases. All publications were identified through PubMed, EMBASE, MEDLINE and Cochrane.

Articles published from 2011 to 2016 were included. Severe ASIA was arbitrarily defined as follows: major organ involvement, life-threatening conditions, intensive treatment, disability, hospitalization and outcome (survival and death).

Cases described before 2011 were excluded. From 2011 to 2016, we identified 4479 ASIA cases, of them 305 fulfilled arbitrary criteria of severe ASIA including our case presentation and 11 deaths.

The majority of severe ASIA cases were related to HPV vaccine, silicone, influenza vaccine and mineral oil injections. The interval from exposition to severe manifestation was from 2 days to 23 years. (1) This is the first study that analyzes all cases published on ASIA with severe manifestations. (2) The current HPV vaccine is both effective and generally safe. However, it should be noted that severe autoimmune side effects have been reported in several studies. Severe ASIA may be observed after influenza vaccines, and other vaccines. (3) Efforts should be made to discover the connection between adjuvants, autoimmunity and autoimmune diseases, because there is an increase in cases severe and life-threatening of ASIA.


The autoimmune/inflammatory syndrome induced by adjuvants (ASIA), presented by Shoenfeld and Agmon-Levin in 2011, is an entity that incorporates diverse autoimmune conditions induced by the exposure to various adjuvants. Adjuvants are agents that entail the capability to induce immune reactions. Adjuvants are found in many vaccines and used mainly to increase the response to vaccination in the general population. Silicone has also been reported to be able to induce diverse immune reactions. Clinical cases and series of heterogeneous autoimmune conditions including systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis have been reported to be induced by several adjuvants. However, only a small number of cases of autoimmune thyroid disorder have been included under the umbrella of ASIA syndrome. Indeed, clinical cases of Hashimoto’s thyroiditis and/or subacute thyroiditis were observed after the exposure to vaccines as well as silicone implantation. In our review, we aimed to summarize the current knowledge on ASIA syndrome presented as endocrinopathies, focusing on autoimmune thyroid disorders associated with the various adjuvants.

 Lupus. 2017 Jan 1:961203316686406. doi: 10.1177/0961203316686406

Autoimmune/inflammatory syndrome induced by adjuvants (Shoenfeld's syndrome) - An update

 Watad A1,2,3, Quaresma M3, Brown S2, Cohen Tervaert JW4, Rodríguez-Pint I5, Cervera R5, Perricone C6, Shoenfeld Y1,3,7

 Author information


Autoimmune/inflammatory syndrome induced by adjuvants (ASIA) has been widely described in many studies conducted thus far. The syndrome incorporates five immune-mediated conditions, all associated with previous exposure to various agents such as vaccines, silicone implants and several others. The emergence of ASIA syndrome is associated with individual genetic predisposition, for instance those carrying HLA-DRB1*01 or HLA-DRB4 and results from exposure to external or endogenous factors triggering autoimmunity. Such factors have been demonstrated as able to induce autoimmunity in both animal models and humans via a variety of proposed mechanisms. In recent years, physicians have become more aware of the existence of ASIA syndrome and the relationship between adjuvants exposure and autoimmunity and more cases are being reported. Accordingly, we have created a registry that includes at present more than 300 ASIA syndrome cases that have been reported by different physicians worldwide, describing various autoimmune conditions induced by diverse adjuvants. In this review, we have summarized the updated literature on ASIA syndrome and the knowledge accumulated since 2013 in order to elucidate the association between the exposure to various adjuvant agents and its possible clinical manifestations. Furthermore, we especially referred to the relationship between ASIA syndrome and systemic lupus erythematosus (SLE) and antiphospholipid syndrome (APS).



 Front Endocrinol (Lausanne). 2017 Jan 24;7:150. doi: 10.3389/fendo.2016.00150. eCollection 2016.

Autoimmune/Inflammatory Syndrome Induced by Adjuvants and Thyroid Autoimmunity.

Watad A1, David P2, Brown S3, Shoenfeld Y4.

Author information


The autoimmune/inflammatory syndrome induced by adjuvants (ASIA), presented by Shoenfeld and Agmon-Levin in 2011, is an entity that incorporates diverse autoimmune conditions induced by the exposure to various adjuvants. Adjuvants are agents that entail the capability to induce immune reactions. Adjuvants are found in many vaccines and used mainly to increase the response to vaccination in the general population. Silicone has also been reported to be able to induce diverse immune reactions. Clinical cases and series of heterogeneous autoimmune conditions including systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis have been reported to be induced by several adjuvants. However, only a small number of cases of autoimmune thyroid disorder have been included under the umbrella of ASIA syndrome. Indeed, clinical cases of Hashimoto's thyroiditis and/or subacute thyroiditis were observed after the exposure to vaccines as well as silicone implantation.

In our review, we aimed to summarize the current knowledge on ASIA syndrome presented as endocrinopathies, focusing on autoimmune thyroid disorders associated with the various adjuvants.


 Cellular & molecular immunology - March 2018 - DOI: 10.1038/cmi.2017.151

 Vaccine-induced autoimmunity: the role of molecular mimicry and immune cross-reaction

Yahel Segal; Yehuda Shoenfeld - Sheba Medical Center


Since the early 1800s vaccines have saved numerous lives by preventing lethal infections. However, during the past two decades, there has been growing awareness of possible adverse events associated with vaccinations, cultivating heated debates and leading to significant fluctuations in vaccination rates. It is therefore pertinent for the scientific community to seriously address public concern of adverse effects of vaccines to regain public trust in these important medical interventions. Such adverse reactions to vaccines may be viewed as a result of the interaction between susceptibility of the vaccinated subject and various vaccine components. Among the implicated mechanisms for these reactions is molecular mimicry. Molecular mimicry refers to a significant similarity between certain pathogenic elements contained in the vaccine and specific human proteins. This similarity may lead to immune cross-reactivity, wherein the reaction of the immune system towards the pathogenic antigens may harm the similar human proteins, essentially causing autoimmune disease.

 In this review, we address the concept of molecular mimicry and its application in explaining post vaccination autoimmune phenomena.

 We further review the principal examples of the influenza, hepatitis B, and human papilloma virus vaccines, all suspected to induce autoimmunity via molecular mimicry.

 Finally, we refer to possible implications on the potential future development of better, safer vaccines.



Dr. Kohls is a retired family physician from Duluth, MN, USA. Since his retirement from his holistic mental health practice he has been writing his weekly Duty to Warn column for the Duluth Reader, northeast Minnesota’s alternative newsweekly magazine. His columns, which are re-published around the world, deal with the dangers of American fascism, corporatism, militarism, racism, malnutrition, Big Pharma’s over-drugging and Big Vaccine’s over-vaccination agendas, as well as other movements that threaten human health, the environment, democracy, civility and the sustainability of all life on earth.  Many of his columns have been archived at a number of websites, including; Dr Gary G. Kohls lives in the USA and writes articles that deal with the dangers of fascism, corporatism, totalitarianism, militarism, racism, malnutrition, and Big Pharma’s over-drugging and over-vaccinating agendas. In addition, his columns deal with cultural movements that threaten democracy, war, civility, health, freedom, the future of the children and the sustainability and livability of the planet.


Dr Kohls is a board member of the National Health Federation ( and is a past member of Mind Freedom International, the International Center for the Study of Psychiatry and Psychology and the International Society for Traumatic Stress Studies. He is a signatory to and/or an advocate of the principles of the Great Barrington Declaration, the World Doctors Alliance and Americas Front Line Doctors.


Dr Kohls practiced holistic medicine and preventive psychiatry for the last decades of his medical career, largely helping the psychologically-wounded, over-medicated survivors of psychiatry that had often been mis-diagnosed and over-medicated with cocktails of neurotoxic, frequently addictive psychiatric drugs that had never been tested for safety when used in combinations.


His Duty to Warn columns have been re-published around the world for the last decade. Dr Kohls frequently writes about Big Vaccine’s over-vaccination agendas and Big Medicine’s over-screening, over-diagnosing and over-treating agendas.


Many of Dr Kohls’ columns have been archived at a number of websites around the world, including:;;; and,%20MD