Watad, Abdulla, Quaresma, Mariana, Bragazzi, Nicola Luigi et al. · Clinical rheumatology · 2018 · DOI
This study examined 300 patients who developed autoimmune diseases after exposure to adjuvants (immune-stimulating substances in vaccines and other products). The most common symptoms were joint pain, muscle pain, and chronic fatigue, and most patients developed another autoimmune condition within about 17 months of exposure. The researchers found that different adjuvants caused slightly different patterns of illness.
This study is relevant to ME/CFS research because it demonstrates that adjuvant exposure can trigger sustained autoimmune and inflammatory responses with fatigue as a cardinal symptom. Understanding ASIA syndrome mechanisms may illuminate post-vaccination or post-infection autoimmune triggers in ME/CFS subgroups, and the registry methodology provides a model for systematically studying rare post-exposure conditions.
This study does not prove that adjuvants cause ME/CFS or that all ME/CFS patients have ASIA syndrome. The registry is observational and retrospective, so it cannot establish causation definitively—temporal association alone does not prove the adjuvant directly caused the autoimmune response. The study also does not address whether ASIA syndrome and ME/CFS share common pathophysiological mechanisms.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Watad, Abdulla, Quaresma, Mariana, Bragazzi, Nicola Luigi, Cervera, Ricard, Tervaert, Jan Willem Cohen, Amital, Howard, et al. (2018). The autoimmune/inflammatory syndrome induced by adjuvants (ASIA)/Shoenfeld's syndrome: descriptive analysis of 300 patients from the international ASIA syndrome registry.. Clinical rheumatology. https://doi.org/10.1007/s10067-017-3748-9
BibTeX
@article{mecfsatlas-watad-2018-autoimmune-inflammatory,
author = {Watad, Abdulla and Quaresma, Mariana and Bragazzi, Nicola Luigi and Cervera, Ricard and Tervaert, Jan Willem Cohen and Amital, Howard and Shoenfeld, Yehuda},
title = {The autoimmune/inflammatory syndrome induced by adjuvants (ASIA)/Shoenfeld's syndrome: descriptive analysis of 300 patients from the international ASIA syndrome registry.},
journal = {Clinical rheumatology},
year = {2018},
doi = {10.1007/s10067-017-3748-9},
note = {PubMed: 28741088},
url = {https://www.mecfsatlas.com/evidence/watad-2018-autoimmune-inflammatory},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-26. https://www.mecfsatlas.com/evidence/watad-2018-autoimmune-inflammatory
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