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Publications

Journal Article Review Ppublish

PubMed: 41937341 DOI: 10.1111/pai.70277

Immediate and delayed hypersensitivity to biologicals in children-A practical approach: An EAACI task force report.

Pediatr Allergy Immunol 37(4):e70277

Authors: Francesca Mori, Marina Atanaskovic-Markovic, Annick Barbaud, Sevim Bavbek, Jean-Christoph Caubet, Leticia de Las Vecillas, Mattia Giovannini, Ekaterina Khaleva, Marina Labella, Luis Moral, Carmen Riggioni, Vito Sabato, Sophia Tsabouri, Stefania Arasi

Affiliations

  • Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
  • University Children's Hospital of Belgrade, Belgrade, Serbia.
  • Faculty of Medicine, University of Belgrade, Belgrade, Serbia.
  • Sante Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP. Sorbonne Université, Paris, France.
  • Département de Dermatologie et Allergologie, Hôpital Tenon, Paris, France.
  • Department of Chest Disease, Division of Immunology and Allergy, Ankara University School of Medicine, Ankara, Türkiye.
  • Pediatric Allergy Unit, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
  • Department of Allergy, La Paz University Hospital, Madrid, Spain.
  • La Paz University Hospital Research Institute (IdiPAZ), Madrid, Spain.
  • Department of Health Sciences, University of Florence, Florence, Italy.
  • Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, UK.
  • Royal Hampshire County Hospital, Winchester, UK.
  • Allergy Research Group, Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina-IBIMA Plataforma BIONAND, Málaga, Spain.
  • Allergy Unit, Hospital Regional Universitario de Málaga, Málaga, Spain.
  • Pediatric Allergy and Respiratory Unit, Dr. Balmis General University Hospital, Alicante, Spain. Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain.
  • Division of Immunology and Allergy, The Hospital for Sick Children and the SickKids Food Allergy and Anaphylaxis Program, Toronto, Ontario, Canada.
  • Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
  • Department of Immunology, Allergology and Rheumatology, University of Antwerp, Antwerpen, Belgium.
  • Department of Immunology, Allergology and Rheumatology, University Hospital Antwerp, Edegem, Antwerp, Belgium.
  • Faculty of Medicine, School of Health Sciences, University of Ioannina, Ioannina, Greece.
  • Translational Research in Pediatric Specialties Area, Division of Allergy, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Abstract

In the era of precision medicine, biologicals demonstrate how therapies can be personalized and directed against new targets. This type of therapy includes different molecules such as growth factors, immune modulators, vaccines, and monoclonal antibodies (mAbs). In recent years, biologicals have been increasingly developed and authorized, although their use in children is limited compared to that in adults, due to the complexity of the pharmacokinetics and pharmacodynamics of the involved proteins, as well as other factors, such as regulations governing clinical trials. Regardless, biologicals are used with efficacy in children to treat various diseases, including oncological, hematological, atopic, and rheumatological diseases. In parallel with the increased use of biologicals, there has been an increase in the unwanted effects of these agents. This paper aims to provide physicians with a practical approach to differentiate between the types of reactions to biologicals in children, especially mAbs, based on the frequency of use, for a comprehensive allergy workup. Starting from a clinical case (i.e., phenotype), specific biomarkers of the involved molecular mechanism (i.e., endotype) are described, providing the reader with currently known instruments to guide the diagnosis. Finally, practical limitations, preventive measures, and unmet needs were discussed by a panel of experts.

MeSH

Hypersensitivity, Hypersensitivity, Delayed, Immune System Diseases, Therapeutics, Child