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Involvement of chronic epipharyngitis in autoimmune (auto-inflammatory) syndrome induced by adjuvants (ASIA)

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The epipharynx is an immunologically active site even under normal conditions, and enhanced immunologic activation is prone to occur in response to an upper respiratory infection, air pollution, and possibly to vaccine adjuvants. Due to the potential link between the central nervous system and immune function, a relationship between epipharyngitis and autonomic nervous disturbance as well as autoimmune disease has been suggested. Various functional somatic symptoms have been described after human papillomavirus (HPV) vaccination, although a causal relationship has not been established. We examined the epipharynx in young women showing functional somatic symptoms following HPV vaccination. Surprisingly, despite having minimal symptoms involving the pharynx, all patients were found to have severe epipharyngitis. In addition, significant improvement in symptoms was seen in most patients who underwent epipharyngeal treatment. Thus, we speculate that the chronic epipharyngitis potentially caused by the vaccine adjuvant may be involved in the pathogenesis of functional somatic syndrome (FSS) post-HPV vaccination. Further, we suggest that epipharyngeal treatment may be effective for various types of FSS regardless of the initial cause, as well as for some autoimmune diseases, and that this may be an important direction in future research.

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Human papillomavirus


Functional somatic syndrome




Autoimmune/inflammatory syndrome induced by adjuvant


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We thank Professors Kensuke Joh and Prof. Yehuda Shoenfeld for their encouragement. We also appreciate Dr. Yoshiteru Aida and Mr. Tatsushi Ohsawa for their contribution to this research.

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Correspondence to Osamu Hotta.

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Osamu Hotta, Ayaki Tanaka, Akira Torigoe, Kazuaki Imai, and Norio Ieiri declare that they have no conflict of interest in this work.

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Hotta, O., Tanaka, A., Torigoe, A. et al. Involvement of chronic epipharyngitis in autoimmune (auto-inflammatory) syndrome induced by adjuvants (ASIA). Immunol Res 65, 66–71 (2017).

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