Abstract

Eosinophilic esophagitis (EoE) is a chronic, immune-mediated disease of the esophagus, marked by eosinophilic infiltration, epithelial barrier dysfunction, and fibrosis. Clinical manifestations vary by age, with infants and young children presenting feeding difficulties, vomiting, and failure to thrive, while older children and adults typically exhibit dysphagia, food impaction, and abdominal discomfort. Th2-mediated inflammation, driven by IL-4, IL-5, and IL-13, promotes eosinophil recruitment and activation, leading to tissue damage and development of symptoms. Conventional therapies – including proton pump inhibitors, corticosteroids, elimination diets, and esophageal dilation – are often insufficient, highlighting the need for targeted biologic treatments. This review summarizes the current evidence from pediatric and adult studies. Dupilumab, an IL-4Rα inhibitor, is the only biologic approved for children with EoE, demonstrating high rates of histologic remission, clinical improvement, and a favorable safety profile. Anti-IL-13 agents (cendakimab, dectrekumab) and anti-IL-5/IL-5Rα agents (reslizumab, mepolizumab, benralizumab) effectively reduce eosinophilic infiltration, though symptomatic benefit, particularly for dysphagia, is variable. Other investigational therapies, including lirentelimab, omalizumab, and etrasimod, show promise, while evidence for vedolizumab, natalizumab, and infliximab remains limited. Biologic therapies offer a novel, targeted approach for pediatric EoE, especially in refractory cases, although further studies are needed to optimize clinical efficacy and long-term safety.

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Authors

Mauro Calvani - Operative Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy

Anna Maria Caroleo - Operative Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy

Margherita Calia - Operative Unit of Pediatrics, S. Camillo-Forlanini Hospital, Rome, Italy

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Copyright (c) 2026 Italian Journal of Pediatric Allergy and Immunology

How to Cite
Calvani, M., Caroleo, A. M., & Calia, M. (2026). Update on Biologic Therapy for Pediatric Eosinophilic Esophagitis. Italian Journal of Pediatric Allergy and Immunology, 39(4). https://doi.org/10.53151/2531-3916/2025-1678
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