The Role of Biologics in the Management of Asthma in the Pediatric Patient

Abstract

The management of pediatric patients with asthma continues to be a major health issue. For many patients, traditional therapies have been very effective, but for a large number of patients asthma remains poorly controlled. This leads to significant morbidity and impairment to quality of life. Recently, several new biologics, as well as new dosage forms of combination inhaled drugs, have been made available for use adding to the armamentarium of therapy for specific asthma phenotypes. Biologics have shown promise in the more difficult to manage asthma patient. Approved in children, omalizumab, an anti–immunoglobulin E (anti-IgE) antibody, has been available for several years. New agents, like mepolizumab and benralizumab, directed against interleukin (IL) 5, have indications for children >6 and >12 years of age, respectively. Dupilumab, an IL-4– and IL-13–directed antibody, has been studied as well in eosinophilic asthma, with positive results. A thorough understanding of the clinical data of these agents is key, as they may greatly improve the quality of life in children with difficult-to-manage asthma.

Biologic Therapies in Pediatric Asthma

“…Thereafter, dendritic cells trigger naïve T helper cells, switching them into TH1, TH17 and TH2 cells [ 2 ]. TH2 cells commence the type 2 pathogenic cascade through signals that cause the production of type 2 cytokines [ 2 , 16 ]. Cytokine expression aids the activation of effector cells that extend airway inflammation and hyperreactivity [ 16 ].…”

“…Additionally, TH2 cells migrate to the airway epithelium and secrete IL-5 and IL-13 [ 2 , 4 ]. IL-4 and IL-13 have been observed to boost IgE production [ 16 ]. IgE coexisting with various allergens prompts the release of acute-acting mediators, such as histamine, leukotrienes, and prostaglandins which act as instigators of vascular permeability and bronchoconstrictor stimuli [ 2 ].…”

“…IgE coexisting with various allergens prompts the release of acute-acting mediators, such as histamine, leukotrienes, and prostaglandins which act as instigators of vascular permeability and bronchoconstrictor stimuli [ 2 ]. Moreover, IL-5 supports maturation and migration of eosinophils [ 16 ]. The upregulation of cytokines creates a vicious cycle as advances activate type 2 mediator cells that enhance the immunological response [ 16 ].…”

“…Moreover, IL-5 supports maturation and migration of eosinophils [ 16 ]. The upregulation of cytokines creates a vicious cycle as advances activate type 2 mediator cells that enhance the immunological response [ 16 ].…”

“…IL-5 is a cardinal cytokine which regulates miscellaneous features of respiratory track eosinophilic inflammation, which is commonly related to augmented asthma severity, including the promotion of eosinophil’s maturation, activation and survival [ 16 , 46 ]. It is well known that eosinophils as well as their chemical mediators have a major role in airway inflammation.…”