ABSTRACT
Autoimmune/autoinflammatory syndrome induced by adjuvants (ASIA) was described in 2011. Over time the condition and its triggers have broadened to include several autoimmune disorders, the macrophagic myofasciitis syndrome, the Gulf war syndrome, the sick building syndrome, siliconosis, and the chronic fatigue syndrome. The aluminum-containing adjuvants in the hepatitis B vaccine and the human papillomavirus vaccine in particular have been stated to be the major causes of the disorder. Here, we review the specificity of the diagnostic criteria for ASIA. We also examine relevant human data, pertaining to causation, particularly from patients undergoing allergen-specific immunotherapy (IT). Patients undergoing allergen-specific IT receive 100 to 500 times more injected aluminum over 3 to 5 years, compared with hepatitis B and human papillomavirus vaccine recipients. In a large pharmacoepidemiological study, in contrast to case series of ASIA, patients receiving aluminum-containing allergen IT preparations were shown to have a lower incidence of autoimmune disease. In another clinical trial, there were no increases in exacerbations in a cohort of patients with systemic lupus erythematosus immunized with the hepatitis B vaccine. Current data do not support the causation of ASIA by vaccine adjuvants containing aluminum, which should be of reassurance to patients undergoing routine immunizations as well as to those undergoing allergen-specific IT.
Subject(s)
Adjuvants, Immunologic/adverse effects , Aluminum/adverse effects , Autoimmune Diseases/diagnosis , Desensitization, Immunologic/methods , Fasciitis/diagnosis , Fatigue Syndrome, Chronic/diagnosis , Myositis/diagnosis , Persian Gulf Syndrome/diagnosis , Allergens/immunology , Aluminum/immunology , Autoimmune Diseases/etiology , Clinical Trials as Topic , Desensitization, Immunologic/adverse effects , Diagnosis, Differential , Fasciitis/etiology , Fatigue Syndrome, Chronic/etiology , Hepatitis B Vaccines/adverse effects , Hepatitis B Vaccines/immunology , Humans , Inflammation , Mass Vaccination , Myositis/etiology , Papillomavirus Vaccines/adverse effects , Papillomavirus Vaccines/immunology , Persian Gulf Syndrome/etiologyABSTRACT
New Zealand has a cancer profile similar to those of Western developed countries, with a high rate of melanoma, similar to Australia. Statistics separating the Maori from the non-Maori population, although open to difficulties in interpretation, show higher rates in Maori of liver, stomach, lung and cervix uterine cancer and lower rates of colorectal cancer and of melanoma. Screening and prevention programmes are limited by resource constraints; there is population screening for cervical cancer and breast cancer screening is being developed. Screening for hepatitis B and liver cancer is proposed, despite conflicting scientific opinions, while screening for colorectal cancer is not planned, despite randomized trial evidence of benefit. There is no clear national cancer control programme at present. Investigation of stomach cancer in Maori families had identified a new gene.