Biologic Therapy and Severe Asthma in Children

Abstract

Severe asthma is a heterogeneous, complex and chronic disease widespread in the pediatric population. According to the recent findings about the different endotypes of asthma in children, each one characterized by specific intracellular molecular pathways, several innovative biologic therapies have been developed. Due to their precise ability to target specific inflammatory type 2 mediators, biologics have revolutionized the care of chronic allergic diseases in the pediatric and adult population. In this review, we aim to provide the latest evidence about the use, indications, efficacy and safety of biologic therapies to treat severe asthma in children and adolescents.

Biologic Therapies in Pediatric Asthma

“…TH2-high asthma is characterized by allergic sensitization and eosinophilic inflammation of the respiratory tract, guided by type 2 prototypical cytokines comprising IL-4, IL-5 and IL-13 [ 12 , 15 ]. TH2 inflammation has presented in a group of patients with severe asthma and has been mostly concentrated in serum IgE levels, eosinophilia and exhaled nitric oxide (FeNO), which are biomarkers useful for the selection of the most suitable biologic factor [ 6 , 10 ].…”

“…It is well known that eosinophils as well as their chemical mediators have a major role in airway inflammation. Mepolizumab is a murine humanized mAb targeting circulating IL-5 and blocking IL-5/IL-5Rα interaction approved by the Food and Drug Administration (FDA) and EMA as an add-on treatment for children with severe eosinophilic asthma ([ 12 ] Table 1 ). Benralizumab is also a humanized mAb targeting the alpha subunit of the cellular receptor of IL-5, approved by FDA and EMA for severe eosinophilic asthma [ 12 ].…”

“…Patients diagnosed with STRA most often need add-on therapeutic strategies [ 11 ]. Aggressive medication management and adherence, the remediation of environmental-inciting inhalants, and treatment of comorbid conditions is obligatory [ 12 ]. All the above result in the cost-effective, rational use of biologics which can target certain TH2 mediators, revolutionizing the management of severe asthma.…”

“…MAbs originate from a B-lymphocyte clone and bind to a matching epitope. Mammalian cells are their main hosts since they can accurately implement post-translational changes [ 12 , 13 ]. From a biopharmaceutical perspective, the superbly targeted selectivity results in lower toxicity due to optimal binding affinity, leadingmAbs to be regarded as groundbreaking and safe treatments [ 14 ].…”

Immunological Targets of Biologic Drugs in Allergic Skin Diseases in Children

“…Monoclonal antibodies (mAbs) are monovalent antibodies that bind to the same epitope with an exquisite targeted selectivity and, therefore, a lower toxicity. mAbs are an innovative therapy for several diseases and their applications are constantly extending, including skin diseases such as AD and urticaria [ 1 ].…”