Immunologic Research

, Volume 66, Issue 1, pp 120–140 | Cite as

Autoimmune/inflammatory syndrome induced by adjuvants—ASIA—related to biomaterials: analysis of 45 cases and comprehensive review of the literature

  • Jaume Alijotas-Reig
  • Enrique Esteve-Valverde
  • Natalia Gil-Aliberas
  • Victor Garcia-Gimenez
Original Article

Abstract

Systemic autoimmune or granulomatous disorders related to biomaterials of human use have rarely been described. The aim of this study was to report cases of autoimmune/inflammatory syndrome induced by adjuvants (ASIA) related to biomaterial injections and prostheses, mainly silicone, hyaluronic acid, acrylamides and methacrylate compounds in a Spanish patient cohort. This study is a retrospective analysis of clinical, laboratory, histopathological and follow-up data of 45 cases of patients suffering from late-onset, non-infectious inflammatory/autoimmune disorders related to bioimplants. Late onset was defined as 3 months or more post injection. Data were obtained through a further non-systematic but comprehensive review of the literature. Forty-five cases of late-onset adverse reactions related to biomaterial injections or prostheses were reviewed. All cases had systemic complaints that could be categorised as ASIA. In all but four patients, inflammatory features at the implantation site preceded distant or systemic manifestations. Abnormal blood tests were common. Localised inflammatory nodules and panniculitis in 40/45 (88.88%) evolved into a variety of disorders, viz., primary biliary cirrhosis, Sjögren’s syndrome, sarcoidosis, human adjuvant disease, vasculitis, inflammatory bowel syndrome and inflammatory polyradiculopathy. Five (11.11%) cases presented primarily with systemic autoimmune disorders. Biomaterials and prostheses can provoke late-onset systemic autoimmune disorders fulfilling ASIA criteria, or present primarily local/regional inflammatory reactions that may eventually evolve into systemic autoimmune and/or granulomatous disorders which fall under ASIA.

Keywords

Adjuvant Adverse reactions ASIA Autoimmune diseases Bioimplants Dermal fillers Granulomatosis 

Abbreviations

ANXA11

Annexin-A11

ACE

Angiotensin-converting enzyme

aFL

Antiphospholipid antibodies

AMA

Antimitochondrial antibodies

ANA

Antinuclear antibodies

ANCA

Antineutrophil cytoplasmic antibodies

ASIA

Autoimmune/inflammatory syndrome induced by adjuvants

ASD

Autoimmune systemic diseases

CD

Cluster differentiation

CRP

C-reactive protein

EBV

Epstein-Barr virus

HA

Hyaluronic acid

HAD

Human adjuvant disease

HLA

Human leukocyte antigen

IL

Interleukin

IFN-γ

Interferon-gamma

MHC

Major histocompatibility complex

NASHA

Non-animal stabilised hyaluronic acid

PBMC

Peripheral blood mononuclear cells

PHA

Phytohaemagglutinin

PLLA

Poly-l-lactic acid

SMG

Silicone medical grade

SS

Sjögren’s syndrome

SPEP

Serum protein electrophoresis

SSc

Systemic sclerosis

TLR

Toll-like receptors

TNF-α

Tumour necrosis factor-alpha

UCTD

Undifferentiated connective tissue disease

Notes

Author’s contributions

All authors have made substantial contributions to all or some of the following: conception and design of the study, acquisition of data, analysis and interpretation of data (JAR, EEV, NGA, VGG), drafting of the article (JAR), critical revision for important intellectual content (JAR, EEV, NGA) and final approval of the version to be submitted (JAR, EEV, NGA, VGG).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2017

Authors and Affiliations

  • Jaume Alijotas-Reig
    • 1
    • 2
  • Enrique Esteve-Valverde
    • 3
  • Natalia Gil-Aliberas
    • 3
  • Victor Garcia-Gimenez
    • 4
    • 5
  1. 1.Systemic Autoimmune Diseases Unit, Department of Internal Medicine-1Vall d’Hebron University HospitalBarcelonaSpain
  2. 2.Department of Medicine, Faculty of MedicineUniversitat Autònoma de BarcelonaBarcelonaSpain
  3. 3.Department of Internal MedicineAlthaia Network Health, ManresaBarcelonaSpain
  4. 4.Europe Medical CentreBarcelonaSpain
  5. 5.Spanish Society of Cosmetic Medicine & SurgeryBarcelonaSpain

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