title: Severe manifestations of autoimmune syndrome induced by adjuvants (Shoenfeld's syndrome).
abstract: 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.
authors.affiliation: Direction of Education and Research, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico. luis_jara_quezada@hotmail.com.|Universidad Nacional Autónoma de México, Mexico City, Mexico. luis_jara_quezada@hotmail.com.
authors.forename: Luis J
authors.initials: LJ
authors.lastname: Jara
authors.affiliation: Research Division, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico.
authors.forename: Grettel
authors.initials: G
authors.lastname: García-Collinot
authors.affiliation: Clinical Research Unit, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico.|Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Gabriela
authors.initials: G
authors.lastname: Medina
authors.affiliation: Research Division, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico.|Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Maria Del Pilar
authors.initials: MDP
authors.lastname: Cruz-Dominguez
authors.affiliation: Internal Medicine Department, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico.|Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Olga
authors.initials: O
authors.lastname: Vera-Lastra
authors.affiliation: Research Division, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico.
authors.forename: Rosa A
authors.initials: RA
authors.lastname: Carranza-Muleiro
authors.affiliation: Rheumatology Department, Hospital de Especialidades Centro Médico Nacional La Raza, IMSS, Seris/Zaachila S/N, Colonia La Raza, Mexico City, Mexico.|Universidad Nacional Autónoma de México, Mexico City, Mexico.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Saavedra
mesh_terms: D000277:Adjuvants, Pharmaceutic / Q000009:adverse effects*; D001327:Autoimmune Diseases / Q000139:chemically induced*; D006801:Humans; D013577:Syndrome
chemical_list: D000277:Adjuvants, Pharmaceutic
keywords: Autoimmune syndrome induced by adjuvants; HPV vaccines; Mineral oil injection; Severe ASIA; Silicone breast implants