Biological Therapies for the Treatment of Severe Asthma in Children

Abstract

Asthma is the most common chronic, non-communicable disease in paediatrics. It is a heterogeneous disease and several phenotypes are described according to symptoms, age of onset, triggers and response to treatment. The characterisation of the inflammatory mechanisms (molecular and cellular), also called endotypes, is more recent and led to the development of more targeted therapies for severe asthma in children, where conventional treatments are not sufficient. Based on the type of bronchial inflammation, there are two endotypes of asthma in children: high T-helpers 2 (TH2) and low TH2. The TH2 endotype is predominant in children, explained by a higher incidence of allergic sensitisation. Three biological therapies, acting on TH2 inflammation, benefit from an intervention from the National Institute for Health and Disability Insurance (NIHDI) in Belgium in children: omalizumab (anti-IgE), mepolizumab (anti-IL-5) and dupilumab (anti-IL-4 and IL-13 a-receptor). When administered in specific situations, these molecules can lead to a significant improvement in patients' symptoms and quality of life. Omalizumab is the best-studied biological therapy in children and is therefore preferred.