Pediatric use of omalizumab for allergic asthma

ABSTRACT

Introduction

Severe pediatric asthma is associated with significant morbidity as well as with a high economic burden. It represents a heterogeneous disease with multiple clinical phenotypes. Currently, physicians are facing the challenge to provide a ‘personalized medicine approach’, which is tailored to the diverse pathomechanisms underlying clinical presentations. Three main endotypes of airway inflammation have been described in children with severe asthma. While neutrophilic and paucigranulocytic inflammatory patterns are quite uncommon in childhood, type Th2 inflammation asthma with elevated IgE is the most prevalent in pediatric asthma. Considering the pivotal role of IgE in type Th2 inflammation asthma, the blockade of IgE using anti-IgE therapy represents a potent therapeutic option for severe pediatric asthma in children.

Areas covered

This review aims to focus on the role of omalizumab as a treatment option in pediatric patients (aged six years and above) with severe allergic asthma.

Expert opinion

The clinical efficacy and safety of omalizumab for the treatment of pediatric asthma is well documented in clinical trials and observational studies. Further studies are still required to characterize the potential benefit of anti-IgE therapy in airway remodeling, identify additional biomarkers of clinical response and address current unmet needs, including the limit on omalizumab use in children younger than six years.

KEYWORDS:

• Asthma
• biologics
• children
• difficult-to-treat asthma
• omalizumab
• precision medicine
• severe asthma

Declaration of interest

The authors have no 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. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Article Highlights

• Severe pediatric asthma represents a heterogeneous disease with multiple clinical phenotypes and is associated with significant morbidity as well as with a high economic burden.

• The ‘personalized medicine approach’ aims to tailor the therapy to the diverse pathomechanisms underlying clinical presentations.

• Omalizumab represents the first available humanized monoclonal anti-IgE therapy with the indication for severe pediatric asthma.

• The clinical efficacy and safety of omalizumab in the pediatric population (aged six years and above) have been well documented.

• Additional studies are required to further identify potential biomarkers of clinical response and address present unmet needs, including current limit on omalizumab use in children younger than six years and in children with total IgE > 1500 IU/mL.

This box summarizes key points contained in the article.

Reviewer Disclosures

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

Additional information

Funding

This paper was not funded.