Choosing biologic therapy in children with severe asthma.

Omalizumab, a monoclonal antibody targeting IgE, was the first biologic therapy approved in 2003 for treating severe, allergen-driven, therapy-resistant asthma. Since then, many new biologics have been approved for use in children, targeting specific pathways, including anti-interleukin (IL)-5 (mepolizumab), IL-5 receptor (benralizumab), IL-4/IL-13 receptor (dupilumab), and thymic stromal lymphopoietin (TSLP) (tezepelumab). As the portfolio of biologics with diverse targets continues to expand, it has brought additional challenges to clinical practice. These include accurately identifying the endotype/phenotype of asthmatic inflammation and determining response criteria. Here, we summarise findings from phase 3 trials, discuss practical considerations for individual patients, and propose an algorithm for initiating biologics in children and adolescents with severe asthma.