Abstract

Introduction. Severe asthma in children is a major clinical challenge, often resistant to conventional treatments.

Materials and methods. An observational study was conducted on 12 children (6-12 years) with severe eosinophilic asthma treated with dupilumab. Clinical, functional, and laboratory parameters were assessed at 3, 6, and 12 months.

Results. There was a significant reduction in exacerbations (from 5.58 to 0.25 episodes/year), oral corticosteroid use (from 16.33 to 3.10 days/year), and improved asthma control (ACT from 21.58 to 23.63). FEV1 increased from 3.19 to 3.45 liters, while FeNO decreased from 17.29 to 13.29 ppb. No serious adverse events occurred.

Discussion. The results demonstrate substantial improvement in asthma control, with a positive impact on quality of life.

Conclusion. Dupilumab is effective and safe for children with severe eosinophilic asthma, supporting its inclusion in standardized treatment protocols.

References

  1. Licari A, Castagnoli R, Brambilla I, et al. Asthma Endotyping and Biomarkers in Childhood Asthma. Pediatr Allergy Immunol Pulmonol 2018;31:44-55. https://doi.org/10.1089/ped.2018.0886.
  2. Cowan K, Guilbert TW. Pediatric asthma phenotypes. Curr Opin Pediatr 2012;24:344-351. https://doi.org/10.1097/MOP.0b013e32835357ab.
  3. Reddy MB, Covar RA. Asthma phenotypes in childhood. Curr Opin Allergy Clin Immunol 2016;16:127-134. https://doi.org/10.1097/ACI.0000000000000252.
  4. Just J, Bourgoin-Heck M, Amat F. Clinical phenotypes in asthma during childhood. Clin Exp Allergy 2017;47:848-855. https://doi.org/10.1111/cea.12939.
  5. Grunwell JR, Rad MG, Stephenson ST, et al. Functional immunophenotyping of children with critical status asthmaticus identifies differential gene expression responses in neutrophils exposed to a poly(I:C) stimulus. Sci Rep 2022;12:19644. https://doi.org/10.1038/s41598-022-24261-y.
  6. Green BJ, Wiriyachaiporn S, Grainge C, et al. Potentially pathogenic airway bacteria and neutrophilic inflammation in treatment resistant severe asthma. PLoS One 2014;9:e100645. https://doi.org/10.1371/journal.pone.0100645.
  7. Dinardo G, Indolfi C, Klain A, et al. Treatment of severe asthma: fast action of dupilumab in the pediatric setting. Minerva Pediatr (Torino) 2023;75:312-313. https://doi.org/10.23736/S2724-5276.21.06437-5.
  8. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-373. Eur Respir J. 2022;59:1362020. https://doi.org/10.1183/13993003.62020-2013. Erratum for: Eur Respir J. 2014;43:343-373. https://doi.org/10.1183/09031936.00202013.
  9. Rajvanshi N, Kumar P, Goyal JP. Global Initiative for Asthma Guidelines 2024: An Update. Indian Pediatr 2024;61:781-786.
  10. Bacharier LB, Jackson DJ. Biologics in the treatment of asthma in children and ado-lescents. J Allergy Clin Immunol 2023;151:581-589. https://doi.org/10.1016/j.jaci.2023.01.002.
  11. Chung KF, Wenzel SE, Brozek JL, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014;43:343-373. https://doi.org/10.1183/09031936.00202013.
  12. Indolfi C, Klain A, Capuano MC, et al. Severe Asthma in School-Age Children: An Updated Appraisal on Biological Options and Challenges in This Age Group. Children (Basel) 2025;12:167. https://doi.org/10.3390/children12020167.
  13. Licari A, Castagnoli R, Denicolò C, et al.; Omalizumab in Childhood Asthma Italian Study Group. Omalizumab in Children with Severe Allergic Asthma: The Italian Real-Life Experience. Curr Respir Med Rev 2017;13:36-42. https://doi.org/10.2174/1573398X13666170426094536.
  14. Humbert M, Busse W, Hanania NA, et al. Omalizumab in asthma: an update on recent developments. J Allergy Clin Immunol Pract 2014;2:525-536.e1. https://doi.org/10.1016/j.jaip.2014.03.010.
  15. Castro M, Corren J, Pavord ID, et al. Dupilumab Efficacy and Safety in Moderate-to-Severe Uncontrolled Asthma. N Engl J Med 2018;378:2486-2496. https://doi.org/10.1056/NEJMoa1804092.
  16. Bacharier LB, Maspero JF, Katelaris CH, et al.; Liberty Asthma VOYAGE Investigators. Dupilumab in Children with Uncontrolled Moderate-to-Severe Asthma. N Engl J Med 2021;385:2230-2240. https://doi.org/10.1056/NEJMoa2106567.
  17. Busse WW, Maspero JF, Rabe KF, et al. Liberty Asthma QUEST: Phase 3 Randomized, Double-Blind, Placebo-Controlled, Parallel-Group Study to Evaluate Dupilumab Efficacy/Safety in Patients with Uncontrolled, Moderate-to-Severe Asthma. Adv Ther 2018;35:737-748. https://doi.org/10.1007/s12325-018-0702-4.

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Authors

Carolina Grella - Department of Woman,Child and General and Specialized Surgery, AOU University of Campania “Luigi Vanvitelli”, Naples, Italy

Cristiana Indolfi - Department of Woman,Child and General and Specialized Surgery, AOU University of Campania “Luigi Vanvitelli”, Naples, Italy

Angela Klain - Department of Woman,Child and General and Specialized Surgery, AOU University of Campania “Luigi Vanvitelli”, Naples, Italy

Fabio Decimo - Department of Woman,Child and General and Specialized Surgery, AOU University of Campania “Luigi Vanvitelli”, Naples, Italy

Michele Miraglia del Giudice - Department of Woman,Child and General and Specialized Surgery, AOU University of Campania “Luigi Vanvitelli”, Naples, Italy

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Copyright (c) 2025 Italian Journal of Pediatric Allergy and Immunology

How to Cite
Grella, C., Indolfi, C., Klain, A., Decimo, F., & Miraglia del Giudice, M. (2025). Biologics and severe asthma: focus on dupilumab and its time to efficacy in the treatment of severe uncontrolled asthma in children - A Single Center Experience. Italian Journal of Pediatric Allergy and Immunology, 39(2). https://doi.org/10.53151/2531-3916/2025-1220
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