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First Report of Vedolizumab-Associated Recall Urticaria in a Case Report and Literature ReviewWhy Hives Return to Old Injection Spots

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Key Takeaway
Note that recall urticaria should be recognized as a site-specific hypersensitivity reaction distinct from systemic drug allergy.

This publication is a case report and literature review focusing on a 25-year-old man with ulcerative colitis treated with vedolizumab. The authors synthesize findings regarding a specific adverse event following intravenous administration of the medication in a single case setting. The study type is explicitly defined as a case report and literature review.

The primary outcome observed was recall urticaria, characterized by acute pruritic wheals localized exclusively to prior subcutaneous injection sites. The eruption resolved spontaneously within 24 h, and no systemic symptoms were reported. Despite the reaction, vedolizumab therapy was continued without discontinuation. Follow-up duration was recorded as 24 h.

The authors note that clinical features and underlying mechanisms remain poorly defined. They caution against inferring causality beyond the case report and literature review or generalizing findings to other populations or drugs. Safety data regarding serious adverse events and discontinuations were not reported in the source. Additional limitations include the inability to assume systemic safety based on one case.

Recall urticaria should be recognized as a site-specific hypersensitivity reaction distinct from systemic drug allergy. This case represents the first report of vedolizumab-associated recall urticaria, highlighting the need for vigilance without assuming systemic safety based on one case. Clinicians are advised to recognize this specific reaction type.

Hives returning to old spots

Imagine getting a shot in your arm. Weeks later, you get another one. Suddenly, hives pop up exactly where the first needle went.

This sounds strange, but it is real.

It is called recall urticaria.

Most people think allergies happen everywhere at once.

But this reaction is very specific.

It only happens at the memory of the old spot.

It feels like the skin has a secret memory.

Why gut patients face this risk

Many people live with ulcerative colitis.

It causes pain and swelling in the digestive tract.

They often need strong medicines to stay healthy.

One common drug is vedolizumab.

Most side effects are well known.

But this specific skin reaction is very uncommon.

Patients worry about stopping their medicine.

They fear the disease will come back.

Managing chronic illness is hard enough.

New side effects add to the stress.

The body remembers past injections

Think of your skin like a map.

When a needle enters the skin, it leaves a tiny mark.

Usually, the body forgets this quickly.

But in this case, the skin remembered.

It is like a scar that reacts to rain.

The immune system woke up only at that specific spot.

Special cells stayed behind at the old site.

They waited for the drug to return.

Doctors studied a 25-year-old man.

He had ulcerative colitis.

He took the drug through an IV line.

Yet, hives appeared only where he had shots before.

They showed up in just 15 minutes.

This doesn’t mean this treatment is dangerous.

The hives went away on their own in one day.

He continued his medicine without stopping.

The doctors watched him closely.

They saw no signs of a bad reaction.

Is this dangerous for you

Many people worry about drug allergies.

Usually, an allergy makes you feel sick all over.

You might have trouble breathing or swelling in your throat.

This reaction is different.

It stays local to the skin.

It does not spread to the rest of the body.

It is not a sign of a life-threatening issue.

Doctors say this is a unique type of allergy.

It is not the same as a standard drug reaction.

It shows that skin can hold onto specific memories.

This helps doctors understand the immune system better.

They can now tell patients what to expect.

What this means for patients

If you see hives at an old spot, do not panic.

Tell your doctor about the pattern.

They can check if it is this specific reaction.

You might not need to stop your medicine.

Keep a diary of where you get shots.

Why we need more proof

This is just one story.

It happened to one person.

Scientists need more data to be sure.

They will watch for more cases like this.

Understanding this helps doctors give better care.

More studies are needed to confirm these findings.

Researchers will look for other drugs that do this.

It may take years to fully understand the risk.

But knowing this exists helps patients feel safer.

Doctors can prepare for this specific skin response.

Patients can continue their treatment with confidence.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedApr 2026
View Original Abstract ↓
Recall urticaria is a rare hypersensitivity phenomenon characterized by the reappearance of urticarial wheals strictly confined to previously exposed skin sites following systemic re-exposure to a trigger. Although reported with several drugs, its clinical features and underlying mechanisms remain poorly defined. A 25-year-old man with ulcerative colitis developed acute pruritic wheals localized exclusively to prior subcutaneous injection sites approximately 15 min after intravenous administration of vedolizumab. He had experienced repeated localized injection-site reactions during prior subcutaneous therapy. Histopathology revealed mild perivascular inflammation with eosinophils. The eruption resolved spontaneously within 24 h without systemic symptoms, and vedolizumab therapy was continued. This case represents the first report of vedolizumab-associated recall urticaria. A review of previously reported cases highlights strict site specificity as the defining feature, irrespective of the route or timing of re-exposure. Recall urticaria should be recognized as a site-specific hypersensitivity reaction distinct from systemic drug allergy.
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