{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:01:06Z","timestamp":1790359266397,"version":"4.1.0"},"reference-count":157,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":24,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Allergy Immunology"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Biologics have revolutionized the treatment of severe allergic diseases in children that cannot be controlled by conventional treatments. These diseases are commonly driven by dysregulation of immune response, often driven by Type 2 pathways. By targeting them, biologics have the potential for treating one or more allergic diseases. Thus, a \u201ctreat to target\u201d strategy is now prioritized, allowing treatment of allergic diseases in a personalized approach. The pioneer anti\u2010IgE monoclonal antibody, omalizumab, was initially indicated for the treatment of moderate to severe allergic asthma and is now indicated for chronic spontaneous urticaria (CSU), chronic rhinosinusitis with nasal polyps (CRSwNP), and food allergy (FA), highlighting the ability of biologics to target multiple allergic diseases. Other biologics have been developed in asthma and other allergic diseases, including mepolizumab (anti\u2010IL5), benralizumab (anti\u2010IL5 receptor), dupilumab (anti\u2013IL\u20104 receptor \u03b1), and more recently tezepelumab (anti\u2010TSLP). Clinical trials in children and\/or teenagers have demonstrated their efficacy and safety, confirmed by real\u2010life studies, in asthma, atopic dermatitis (AD), CSU, and more recently in eosinophilic esophagitis (EoE) and FA. Beyond biologics, small molecules such as Janus kinase inhibitors target other key pathways and have already been approved in AD, with ongoing clinical trials in other allergic diseases. In the pediatric specific context, these treatments raise questions, particularly regarding the choice of biologics and the goals. In the long term, the sustained efficacy, safety and impact on the natural history of allergic diseases need to be further studied. The aim of this review is to discuss the most recent data in the use of biologics and small molecules in pediatric allergic diseases and to highlight the remaining gaps in knowledge.<\/jats:p>","DOI":"10.1111\/pai.70454","type":"journal-article","created":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T17:07:19Z","timestamp":1790356039000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Update on biologic and small molecules treatments in pediatric allergic diseases"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2068-5524","authenticated-orcid":false,"given":"Herman T.","family":"den Dekker","sequence":"first","affiliation":[{"name":"Department of Pediatrics\/Pediatric Respiratory Medicine and Allergology, Erasmus MC \u2013 Sophia Children's Hospital University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2492-9864","authenticated-orcid":false,"given":"Amandine Divaret","family":"Chauveau","sequence":"additional","affiliation":[{"name":"Pediatric Allergy Unit, Children's Hospital University Hospital of Nancy  Vandoeuvre les Nancy France"},{"name":"UR 3450 DevAH, Campus Brabois Sant\u00e9 University of Lorraine  Vandoeuvre les Nancy France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1162-1027","authenticated-orcid":false,"given":"Benoit","family":"Sterling","sequence":"additional","affiliation":[{"name":"Aix\u2010Marseille Univ APHM, H\u00f4pital Timone, Service de Dermatologie\u2010V\u00e9n\u00e9r\u00e9ologie  Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6486-7487","authenticated-orcid":false,"given":"St\u00e9phanie","family":"Coopman","sequence":"additional","affiliation":[{"name":"Department of Pediatric Gastroenterology Hepatology and Nutrition, Centre Hospitalier Universitaire Lille Reference Center for Congenital Oesophageal Anomalies  Lille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2467-4256","authenticated-orcid":false,"given":"R. 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Lille, CHU de Lille, Service de Pneumologie et d'Allergologie P\u00e9diatrique, H\u00f4pital Jeanne de Flandre  Lille France"},{"name":"INSERM Unit 1019, CNRS UMR 9017, CHU Lille, Institut Pasteur de Lille, Center for Infection and Immunity of Lille Universit\u00e9 de Lille  Lille Cedex France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8285-4506","authenticated-orcid":false,"given":"Dorothea","family":"Holter","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Karl Landsteiner University  Krems Austria"},{"name":"Department of Pediatric and Adolescent Medicine University Hospital St. P\u00f6lten  St. P\u00f6lten Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2914-7829","authenticated-orcid":false,"given":"Thomas","family":"Eiwegger","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Adolescent Medicine Karl Landsteiner University  Krems Austria"},{"name":"Department of Pediatric and Adolescent Medicine University Hospital St. P\u00f6lten  St. P\u00f6lten Austria"},{"name":"Translational Medicine Program, Research Institute Hospital for Sick Children  Toronto Ontario Canada"},{"name":"Department of Immunology University of Toronto, Temerty Faculty of Medicine  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"St\u00e9phanie","family":"Mallet","sequence":"additional","affiliation":[{"name":"Aix\u2010Marseille Univ APHM, H\u00f4pital Timone, Service de Dermatologie\u2010V\u00e9n\u00e9r\u00e9ologie  Marseille France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0902-0860","authenticated-orcid":false,"given":"Mari\u00eblle W.","family":"Pijnenburg","sequence":"additional","affiliation":[{"name":"Department of Pediatrics\/Pediatric Respiratory Medicine and Allergology, Erasmus MC \u2013 Sophia Children's Hospital University Medical Center Rotterdam  Rotterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2006-7221","authenticated-orcid":false,"given":"Antoine","family":"Deschildre","sequence":"additional","affiliation":[{"name":"Univ. 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