Antigen-specific recall urticaria to a peptide-based vaccine

Abstract

Recall urticaria (RU) is a localized urticarial response that occurs at a site of previous antigen injection on reexposure to that antigen at a remote site.1 The response is rare and typically associated with allergy immune therapies. The mechanism for RU is poorly understood, but possibilities include increased accumulation and degranulation of mast cells at the site of previous allergy injections.1 RU has not been described in the setting of peptide-based vaccines. In recent years several immunogenic proteins associated with human malignancies have been identified, allowing the development of antigen-specific cancer vaccines.2 Our group has focused on the HER-2/neu oncoprotein as a tumor antigen. HER-2/neu is a cancer-related protein that is overexpressed in 30% of breast and ovarian cancers. Studies in animal models have demonstrated that HER-2/neu peptide-based vaccines, mixed with GM-CSF as an adjuvant, effectively generate HER2/neu-specific immunity.3 A phase-I trial of HER-2/neu peptide-based vaccines was approved by both the University of Washington Human Subjects Division and the United States Food and Drug Administration. Patients with stable stage III or IV breast, ovarian, or non-small cell lung cancers were vaccinated monthly for 6 months. GM-CSF was used as a vaccine adjuvant. This case report describes 1 patient in whom RU developed 30 days after the last vaccination.