Biologic therapy for chronic spontaneous urticaria in pediatrics and adolescents: current landscape, challenges, and future perspectives

ABSTRACT

Introduction

Chronic spontaneous urticaria (CSU) poses significant challenges, especially in pediatric and adolescent patients, impacting physical, emotional, and social well-being. Recent biologic breakthroughs offer promise, however, data on safety and efficacy in this population remain limited.

Areas covered

This review examines current biologic treatments in pediatrics and adolescents with CSU and explores the rapidly emerging landscape.

Expert opinion

Despite omalizumab’s approval for allergic asthma in children since 2009, its delayed approval for CSU raises questions. Ligelizumab, a next-generation anti-IgE mAb, showed effectiveness in adults but lacks pediatric studies. CT-P39, a biosimilar to omalizumab, demonstrates promise, yet adolescent-specific outcomes are undisclosed. Dupilumab’s recent approval for atopic dermatitis in children from 6 months onwards signifies progress. Expert opinion underscores the scarcity of controlled trials in pediatric and adolescent CSU, emphasizing the need for comprehensive studies. Age-specific data and collaboration are crucial for addressing research gaps and expanding indications for pediatric CSU treatment. The recently validated UAS7 parameter in children marks a milestone for prospective clinical trials. Despite challenges, the biology therapy outlook for pediatric and adolescent CSU is promising. Importantly, studies indicate that pediatric CSU is at least as prevalent as in adults, highlighting the need for approved treatments in this population.

KEYWORDS:

• Chronic spontaneous urticaria
• pediatric
• biologic therapy
• omalizumab
• ligelizumab
• CT-P39
• dupilumab
• controlled trials

Article highlights

• Limited data on biologic therapy in pediatric and adolescent chronic spontaneous urticaria (CSU).

• Omalizumab’s delayed approval for pediatric and adolescent CSU raises concerns.

• Ligelizumab lacks pediatric and adolescent studies despite effectiveness in adults.

• CT-P39 and dupilumab show promise, necessitating further research.

• Urgent need for age-specific data, collaborative efforts, and expanded indications in pediatric CSU treatment.

Declaration of interest

KM Duda has received honoraria for lectures and advisory boards of Biocryst, CSL Behring and Takeda. B Wedi has received honoraria for lectures and advisory boards of ALK-Abelló, Bencard, CSL-Behring, Biocryst, Kalvista, Novartis, Sanofi-Aventis, Takeda and ThermoFisher. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.