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Seida I, Alrais M, Seida R, Alwani A, Kiyak Z, Elsalti A, Nil Esirgun S, Abali T, Mahroum N. Autoimmune/inflammatory syndrome induced by adjuvants (ASIA): past, present, and future implications. Clin Exp Immunol 2023; 213:87-101. [PMID: 36881788 PMCID: PMC10324553 DOI: 10.1093/cei/uxad033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 02/06/2023] [Accepted: 03/06/2023] [Indexed: 03/09/2023] Open
Abstract
Adjuvants, as the name indicates, are adjoined material aimed to assist in functioning as when added to vaccines they are meant to boost the effect and strongly stimulate the immune system. The response of the immune system can be unpredictable, and the autoimmune/inflammatory syndrome induced by adjuvants (ASIA) was developed to address possible adverse reactions of an autoimmune and inflammatory type that may be caused by adjuvants. While ASIA, as a syndrome, was coined and defined in 2011; reports describing patients with vague and nonspecific clinical symptoms following vaccinations appeared much earlier. In other words, ASIA came to define, arrange, and unite the variety of symptoms, related to autoimmunity, caused not by the vaccine itself, rather by the adjuvant part of the vaccine such as aluminum, among others. Accordingly, the introduction of ASIA enabled better understanding, proper diagnosis, and early treatment of the disorder. Furthermore, ASIA was shown to be associated with almost all body systems and various rheumatic and autoimmune diseases such as systemic lupus erythematosus, antiphospholipid syndrome, and systemic sclerosis. In addition, the correlation between COVID-19 and ASIA was noticed during the pandemic. In this review, we summarized the reported effects of adjuvants and medical literature before and after ASIA was defined, the several ways ASIA can manifest and impact different systems of the body, and the incidences of ASIA during the COVID-19 pandemic. It is important to clarify, that vaccines are among, if not the, most effective means of fighting infectious diseases however, we believe that vaccines manufacturing is not above criticism, particularly when it comes to added substances possessing a risk of side effects.
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Affiliation(s)
- Isa Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Mahmoud Alrais
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Ravend Seida
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulkarim Alwani
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Zeynep Kiyak
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Abdulrahman Elsalti
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Sevval Nil Esirgun
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Tunahan Abali
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
| | - Naim Mahroum
- International School of Medicine, Istanbul Medipol University, Istanbul, Turkey
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Gen S, Iwai T, Ohnari S, Nobe K, Ikeda N. ANCA-Associated Vasculitis after Moderna COVID-19 Vaccination. Case Rep Nephrol 2023; 2023:4906876. [PMID: 37101523 PMCID: PMC10125765 DOI: 10.1155/2023/4906876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 03/17/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023] Open
Abstract
We experienced a case of myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA)-associated vasculitis after Moderna COVID-19 vaccination. An 82-year-old woman developed pyrexia and general malaise one month after her third booster vaccine, and the symptoms persisted. Blood testing revealed inflammation, a high level of MPO-ANCA, and microscopic hematuria. MPO-ANCA-associated vasculitis was diagnosed by renal biopsy. The symptoms improved with steroid therapy. Common adverse reactions to mRNA vaccines against COVID-19 include pyrexia and general malaise, but MPO-ANCA-associated vasculitis can also occur. If pyrexia, prolonged general malaise, urinary occult blood, or renal impairment is observed, the onset of MPO-ANCA-associated vasculitis should be considered.
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Affiliation(s)
- Shiko Gen
- Department of Nephrology, Saitama Sekishinkai Hospital, Sayama, Japan
| | - Takanori Iwai
- Department of Nephrology, Saitama Sekishinkai Hospital, Sayama, Japan
| | - Sayuri Ohnari
- Department of Nephrology, Saitama Sekishinkai Hospital, Sayama, Japan
| | - Kanako Nobe
- Department of Nephrology, Saitama Sekishinkai Hospital, Sayama, Japan
| | - Naofumi Ikeda
- Department of Nephrology, Saitama Sekishinkai Hospital, Sayama, Japan
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Greb CS, Aouhab Z, Sisbarro D, Panah E. A Case of Giant Cell Arteritis Presenting After COVID-19 Vaccination: Is It Just a Coincidence? Cureus 2022; 14:e21608. [PMID: 35228965 PMCID: PMC8873313 DOI: 10.7759/cureus.21608] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2022] [Indexed: 02/06/2023] Open
Abstract
Giant cell arteritis (GCA) is a large vessel vasculitis with variable presentations, including fevers, myalgias, headache, and jaw claudication. A particularly concerning symptom is transient vision loss, which may become irreversible without prompt recognition and treatment. The pathogenesis of GCA is incompletely understood, but it seems that the innate and adaptive immune systems play a key role in vessel inflammation, remodeling, and occlusion. We present a case of a 79-year-old male who developed GCA two days after he received his second dose of a COVID-19 mRNA vaccine. He presented with headaches, fever, and myalgias. Lab workup revealed elevated inflammatory markers, with C-reactive protein (CRP) 272 mg/L (<8.1 mg/L) and erythrocyte sedimentation rate (ESR) 97 mm/hr (0-20mm/hr). Imaging of the head, with CT and MRI, was unremarkable. His headache persisted despite supportive treatment, and he developed new, transient blurred vision, which increased suspicion for GCA. He underwent bilateral temporal artery biopsies, which were consistent with GCA. His symptoms resolved quickly with oral prednisone 60mg daily, and his inflammatory markers returned to normal within a month. A review of the literature revealed several case reports of giant cell arteritis following influenza vaccination. However, no large-scale studies have demonstrated a causal relationship between GCA and immunization. Our case demonstrates the first instance of GCA following a COVID-19 mRNA vaccine. We propose that the upregulated immune response to the vaccine acted as a trigger for GCA in this patient with predisposing factors. While causation cannot be determined based on one case alone, our case demonstrates an opportunity for further research into the relationship between vasculitis and immunizations. Despite this isolated case, the proven benefits of COVID-19 mRNA vaccines significantly outweigh any theoretical risk of immune dysregulation following administration.
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Affiliation(s)
| | - Zineb Aouhab
- Rheumatology, Loyola University Medical Center, Maywood, USA
| | - Daniel Sisbarro
- Internal Medicine, Loyola University Medical Center, Maywood, USA
| | - Elnaz Panah
- Pathology, Loyola University Medical Center, Maywood, USA
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Nichani P, Micieli JA. Granuloma Annulare, Scalp Necrosis, and Ischemic Optic Neuropathy From Giant Cell Arteritis After Varicella-Zoster Virus Vaccination. J Neuroophthalmol 2021; 41:e145-e148. [PMID: 32235218 DOI: 10.1097/wno.0000000000000947] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Prem Nichani
- Faculty of Medicine (PN), University of Toronto, Toronto, Canada ; Department of Ophthalmology and Vision Sciences (JAM), University of Toronto, Toronto, Canada ; and Division of Neurology (JAM), Department of Medicine, University of Toronto, Toronto, Canada
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Liozon E, Parreau S, Filloux M, Dumonteil S, Gondran G, Bezanahary H, Ly KH, Fauchais AL. Giant cell arteritis or polymyalgia rheumatica after influenza vaccination: A study of 12 patients and a literature review. Autoimmun Rev 2020; 20:102732. [PMID: 33326851 DOI: 10.1016/j.autrev.2020.102732] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/24/2020] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory rheumatic diseases common in people over the age of 50 years. Seasonal influenza vaccination (IV) is strongly recommended in this population, among whom it is considered to be effective and well tolerated. IV-induced GCA or PMR are thought to be exceptional. PATIENTS AND METHODS We retrieved all post-IV cases from an inception cohort of patients with newly diagnosed GCA. We also included two patients with post-IV PMR and reviewed all published reports of post-IV GCA or PMR, with selection of cases demonstrating disease onset within 1 month following IV. We compared the results of HLA-DRB1 typing, performed in seven patients with post-IV GCA or PMR, with those of 11 GCA patients with familial aggregation and 16 randomly selected GCA patients without a reported trigger. RESULTS Of 358 GCA recruited since 2002, 10 (2.8%) qualified for post-IV GCA, of whom two also showed familial aggregation. Thirty-two patients (19 with GCA and 13 with PMR) including our patients were reviewed; their mean age was 71.8 ± 7.4 years and the M/F ratio was 0.8. Six patients (19%) had a history of PMR. Patients with post-IV GCA/PMR had the DRB1*13:01 haplotype more frequently compared to those with familial GCA (5/7 vs. 2/11, p = 0.048) or with GCA without a known trigger (3/16, p = 0.026). Post-IV PMR generally appeared self-limited, whereas post-IV GCA often displayed a more protracted course (chronic relapsing disease in one-third of the patients). CONCLUSION Post-IV onset of GCA/PMR is not an exceptional occurrence and may be part of the spectrum of the autoimmune syndrome induced by adjuvants (ASIA). IV can trigger GCA or PMR, especially in persons at higher spontaneous risk, such as those with a personal or familial history of GCA/PMR. Whether the presence of the DRB1*13:01 allele further increases the risk of post-IV GCA/PMR through a stronger vaccine-induced immune reaction deserves further investigation. Unlike PMR, GCA can be a serious complication of IV.
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Affiliation(s)
- Eric Liozon
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France.
| | - Simon Parreau
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Matthieu Filloux
- Immunology and Immunogenetics, University Hospital of Limoges, Limoges Cedex, France
| | - Stéphanie Dumonteil
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Guillaume Gondran
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Holy Bezanahary
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - K H Ly
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
| | - Anne Laure Fauchais
- Departments of Internal Medicine, University Hospital of Limoges, Limoges Cedex, France
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The value of Autoimmune Syndrome Induced by Adjuvant (ASIA) - Shedding light on orphan diseases in autoimmunity. Autoimmun Rev 2018. [DOI: 10.1016/j.autrev.2017.11.037] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Vaccinations and risk of systemic lupus erythematosus and rheumatoid arthritis: A systematic review and meta-analysis. Autoimmun Rev 2017; 16:756-765. [PMID: 28483543 DOI: 10.1016/j.autrev.2017.05.012] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/23/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In the past several years, more and more studies proposed some concerns on the possibly increased risk of autoimmune diseases in individuals receiving vaccinations, but published studies on the associations of vaccinations with risks of systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA) reported conflicting findings. A systematic review and meta-analysis was carried out to comprehensively evaluate the relationship between vaccinations and risk of SLE and RA. METHODS Pubmed, Web of Science and Embase were searched for observational studies assessing the associations of vaccinations with risks of RA and SLE. Two authors independently extracted data from those eligible studies. The quality of eligible studies was assessed by using the Newcastle-Ottawa Scale (NOS). The pooled relative risk (RR) with 95% confidence intervals (CIs) was used to measure the risk of RA and SLE associated with vaccinations, and was calculated through random-effect meta-analysis. RESULTS Sixteen observational studies were finally considered eligible, including 12 studies on the association between vaccinations and SLE risk and 13 studies on the association between vaccinations and RA risk. The pooled findings suggested that vaccinations significantly increased risk of SLE (RR=1.50; 95%CI 1.05-2.12, P=0.02). In addition, there was an obvious association between vaccinations and increased risk of RA (RR=1.32; 95%CI 1.09-1.60, P=0.004). Meta-analysis of studies reporting outcomes of short vaccinated time also suggested that vaccinations could significantly increase risk of SLE (RR=1.93; 95%CI 1.07-3.48, P=0.028) and RA (RR=1.48; 95%CI 1.08-2.03, P=0.015). Sensitivity analyses in studies with low risk of bias also found obvious associations of vaccinations with increased risk of RA and SLE. CONCLUSION This study suggests that vaccinations are related to increased risks of SLE and RA. More and larger observational studies are needed to further verify the findings above and to assess the associations of vaccinations with other rheumatic diseases.
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Li WH, Cao DY, Shen K, Yang JX. A Rare Case of Ovarian Cancer Presenting with Paraneoplastic Cerebellar Degeneration and Limbic Encephalitis. Chin Med J (Engl) 2015; 128:2685-7. [PMID: 26415811 PMCID: PMC4736848 DOI: 10.4103/0366-6999.166028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
| | | | | | - Jia-Xin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Science, Beijing 100730, China
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Sejvar J. Vaccines and viral / toxin-associated neurologic infections. HANDBOOK OF CLINICAL NEUROLOGY 2014; 123:719-44. [PMID: 25015514 DOI: 10.1016/b978-0-444-53488-0.00038-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- James Sejvar
- Division of Viral and Rickettsial Diseases, Division of Vector-Borne Infectious Diseases, National Center for Zoonotic, Vectorborne, and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Palacios AI, Rodríguez M, Martín MD. [Central serous chorioretinopathy of unusual etiology: A report of 2 cases]. ACTA ACUST UNITED AC 2013; 89:275-8. [PMID: 24269442 DOI: 10.1016/j.oftal.2013.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 02/21/2013] [Accepted: 04/12/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Describe 2 rare causes of central serous chorioretinopathy. CLINICAL CASES Case 1: A 35 year old woman with loss of vision in her left eye, with a recent history of a flu vaccination. This could have been the process that triggered an immune response, with increased circulating immune complexes that favour choroidal ischemia. CASE 2 A 41 year old man with loss of vision in his left eye. As history, had consumed cocaine, which could be related to its adrenergic effect adrenergic, and earlier excimer laser refractive surgery (LASIK). CONCLUSION In both cases there was a temporal relationship between cause and effect.
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Affiliation(s)
- A I Palacios
- Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Parla, Madrid, España.
| | - M Rodríguez
- Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Parla, Madrid, España
| | - M D Martín
- Servicio de Oftalmología, Hospital Universitario Infanta Cristina, Universidad Complutense de Madrid, Parla, Madrid, España
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Soriano A, Manna R. Giant cell arteritis and polymyalgia rheumatica after influenza vaccination: comparing different experiences. J Dermatol 2012; 39:888-9. [PMID: 22671765 DOI: 10.1111/j.1346-8138.2012.01594.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Soriano A, Verrecchia E, Marinaro A, Giovinale M, Fonnesu C, Landolfi R, Manna R. Giant cell arteritis and polymyalgia rheumatica after influenza vaccination: report of 10 cases and review of the literature. Lupus 2012; 21:153-7. [DOI: 10.1177/0961203311430222] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Giant cell arteritis (GCA) and polymyalgia rheumatica (PMR) are inflammatory rheumatic diseases common in people over the age of 50 years. Herein, we report 10 cases of previously healthy subjects who developed GCA/PMR within 3 months of influenza vaccination (Inf-V). A Medline search uncovered additional 11 isolated cases of GCA/PMR occurring after Inf-V. We discuss the role of individual susceptibility, the potential function of immune adjuvants as triggers of autoimmunity post-vaccination, and the correlation of our observation with the ‘ASIA’ syndrome, i.e. autoimmune/inflammatory syndrome induced by adjuvants and including post-vaccination phenomena.
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Affiliation(s)
| | | | | | | | | | - R Landolfi
- Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
| | - R Manna
- Clinical Autoimmunity Unit
- Periodic Fevers Research Centre
- Department of Internal Medicine, Catholic University of the Sacred Heart, Rome, Italy
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Konishi M, Koarada S, Yamaguchi K, Tashiro S, Soejima S, Suematsu R, Inoue H, Tada Y, Ohta A, Nagasawa K. [Case of microscopic polyangiitis and giant cell arteritis after influenza vaccination]. ACTA ACUST UNITED AC 2011; 34:154-61. [PMID: 21720104 DOI: 10.2177/jsci.34.154] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of microscopic polyangiitis (mPA) and giant cell arteritis (GCA) (polyangiitis overlap syndrome) after influenza vaccination. A 67-year-old female with chronic kidney disease, who had been observed by a physician, presented fever and headache after immunization of influenza vaccine. She was diagnosed as having with mPA and GCA based on symptoms, worsening of renal function, biopsy of temporal artery (giant cell arteritis) and skin (microscopic polyangiitis), pulmonary involvement and the presence of myeloperoxidase-specific anti-neutrophil cytoplasmic antibodies (MPO-ANCA). She was treated with prednisolone (PSL) and the symptoms were improved. However, two months later she was presented with general physical weariness. She was diagnosed as having with pneumocystis pneumonia, cytomegalovirus infection and cryptococcosis. Despite intensive treatment, she was died and autopsy was performed. The present case suggests that the influenza vaccination may cause different types of vasculitis, mPA and GCA, through the common mechanism in pathophysiology. This patient is also the first case of mPA and GCA proven by histological examination.
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Affiliation(s)
- Mai Konishi
- Division of Rheumatology, Saga University, Saga, Japan
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Wu YJ, Lai ML, Huang CW. Reversible postvaccination paraneoplastic encephalomyelitis in a patient with lung adenocarcinoma. Int J Neurosci 2010; 120:792-5. [PMID: 20964557 DOI: 10.3109/00207454.2010.520380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Encephalomyelitis occurs in paraneoplastic syndrome and acute disseminated encephalomyelitis through different autoimmune mechanisms. No postvaccinal encephalomyelitis other than acute disseminated encephalomyelitis has been reported in patients with malignancy. A 68-year-old woman was admitted because of a headache followed by a gait disturbance and psychomotor retardation 2 days after she had received an influenza vaccination followed by abulia, limb rigidity and hyperreflexia of both legs, and meningeal irritation. Cerebrospinal fluid studies showed increased intracranial pressure, elevated immunoglobulins G and A, and pleocytosis. Contrasted brain magnetic resonance imaging revealed ventriculomegaly and multiple symmetric leptomeningeal enhancement, without demyelinating changes or cortical ribbon signs. Somatosensory evoked potentials and nerve conduction velocity studies suggested myelitis. Encephalomyelitis was diagnosed on the basis of clinical and laboratory examinations. The etiological survey identified a lung adenocarcinoma. Both the encephalomyelitis and the lung adenocarcinoma simultaneously progressed after the vaccination and then, after targeted therapy for lung cancer, simultaneously subsided. In conclusion, postinfluenza-vaccination paraneoplastic encephalomyelitis may occur in patients with lung adenocarcinoma.
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Affiliation(s)
- Yi-Jen Wu
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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