The severity, heterogeneity, and prevalence of type 2 inflammatory diseases, including atopic dermatitis (AD) and asthma, pervasively rising, especially in adolescents and children, bearing the highest-burden in healthcare expenses and morbidity. Although allergen immunotherapy has disease‐modifying properties and confers long‐term clinical benefit after cessation of treatment, its indication is still limited to patients with clinically significant immunoglobulin E (IgE)‐mediated respiratory allergies. Type 2 inflammation is sustained by a specific subset of cytokines, such as interleukin (IL)‐4, IL‐5, IL‐13, and IgE, resulting in cell recruitment like eosinophils, basophils, and mast cells into the affected tissues.
For children with severe therapy‐resistant asthma, omalizumab, mepolizumab, and dupilumab are all available options. Omalizumab is licensed for moderate‐to‐severe allergic asthma in patients greater than or equal to six years old. Several randomized controlled trials and real‐life studies have shown that omalizumab reduces the rate of asthma exacerbations and hospital admissions in children. By possibly increasing antiviral response (IFN‐α) from DCs, omalizumab also reduces virus‐associated exacerbations. Mepolizumab reduced asthma attacks and hospitalizations and reduced the dose of maintenance oral corticosteroids. In the 6‐11 years age group, safety and pharmacokinetic data are available, with only minimal efficacy data. A phase 2 trial is actively recruiting children to explore the effect of mepolizumab adjunctive therapy in preventing asthma exacerbations.
In conclusion, a better grasp of the type 2 inflammatory pathways is essential to implement the targeted therapeutic approach in children susceptible to allergic diseases, such as atopic dermatitis and severe forms of asthma. The studies that compared the different biologics require the need for broader pediatric trials, including children with Type II diseases, to explore safety issues, identify predictive biomarkers of biologic therapies, and expand the efficacy data for future research.