Journal Article Review Epublish
PubMed: 42829647 DOI: 10.2147/ITT.S624173
Exploring the Potential Benefits of Biologic Therapies Beyond Respiratory Allergy.
Immunotargets Ther 15:624173
Authors: Rossella Sica, Francesco CatamerĂ², Simone Foti Randazzese, Francesca Galletta, Amelia Licari, Gian Luigi Marseglia, Francesca Mori, Remo Poto, Federica Pulvirenti, Silvia Ricci, Mattia Giovannini, Sara Manti
Affiliations
- Department of Pediatrics, "San Luca" Hospital, Vallo della Lucania, ASL Salerno, Italy.
- Department of Health Sciences, University of Florence, Florence, Italy.
- Allergy Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Pavia, Italy.
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
- Pediatric Unit, Department of Human Pathology of Adult and Childhood Gaetano Barresi, University of Messina, Messina, Italy.
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.
- Reference Centre for Primary Immune Deficiencies, Sapienza University Hospital Policlinico Umberto I, Rome, Italy.
- Immunology Unit, Meyer Children's Hospital IRCCS, Florence, Italy.
Abstract
Severe pediatric asthma is a heterogeneous inflammatory disease that is most commonly driven by type 2 (T2) inflammation. Because respiratory viral infections are the leading triggers of asthma exacerbations in children, this review examines the effects of biologic therapies on infection-related outcomes and antiviral immune function, beyond their established role in asthma control. We conducted a structured narrative review of literature published from January 2000 through February 2026 using PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library databases. Studies evaluating infection-related outcomes and immune effects of biologic therapies in pediatric asthma were analyzed. Available evidence consistently indicates that biologics have favorable infectious safety profiles without increasing the risk of serious or opportunistic infections. Anti-IgE therapy (omalizumab) showed the strongest evidence of direct immunomodulatory effects, including restoration of interferon-mediated antiviral responses and reduction of virus-triggered asthma exacerbations. Anti-IL-5 and anti-IL-5 receptor therapies have corticosteroid-sparing effects and preserve immune competence despite eosinophil depletion. Dupilumab and tezepelumab similarly provide sustained efficacy and stable safety profiles without increasing infectious burden. Real-world evidence from the COVID-19 pandemic further indicates that biologic-treated children do not have greater susceptibility to SARS-CoV-2 infection or more severe disease. Overall, biologic therapies appear to provide targeted immunomodulation rather than broad immunosuppression, preserving host defense while controlling severe pediatric asthma. These findings suggest that biologic therapies may positively influence immune competence beyond asthma control, with implications for infection susceptibility and antiviral defense. Further prospective pediatric studies with standardized endpoints and long-term follow-up are needed to define their immunological impact and optimize precision-medicine strategies.
MeSH
Omalizumab, Safety, Hypersensitivity, Covid-19, Therapeutics, Asthma, Biological Therapy, Antiviral Agents, Infections, Child, Allergy