Shoenfeld and Agmon-Levin reported criteria for the diagnosis of autoimmune/inflammatory syndrome induced by adjuvants (ASIA). This is name given to a group of conditions that may be induced by exposure to a xenobiotic having immune adjuvant properties.
Major criteria:
(1) presence of an external stimulus (infection, vaccine, silicone, adjuvant, etc) prior to onset of clinical manifestations
(2) presence of "typical" clinical manifestations
(3) clinical improvement occurs if inciting agent is removed
(4) biopsy of involved organs show typical pathologic findings
Minor criteria:
(1) appearance of autoantibodies or antibodies direct at the suspected adjuvant
(2) other clinical findings (irritable bowel syndrome, etc)
(3) specific HLA (HLA DRB1, HLA DQB1)
(4) evolution of an autoimmune disease
Typical clinical findings:
(1) myalgia, myalgia or muscle weakness
(2) arthralgia and/or arthritis
(3) chronic fatigue, un-refreshing sleep, or sleep disturbances
(4) neurological manifestation
(5) cognitive impairment or memory loss
(6) pyrexia
(7) dry mouth
Differential diagnosis:
(1) autoimmune disease unrelated to external stimulus
(2) toxic exposure without immune effect
