{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,24]],"date-time":"2025-12-24T12:32:31Z","timestamp":1766579551566,"version":"build-2065373602"},"reference-count":66,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2020,4,24]],"date-time":"2020-04-24T00:00:00Z","timestamp":1587686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>In asthmatic adults, monoclonals directed against Type 2 airway inflammation have led to major improvements in quality of life, reductions in asthma attacks and less need for oral corticosteroids. The paediatric evidence base has lagged behind. All monoclonals currently available for children are anti-eosinophilic, directed against the T helper (TH2) pathway. However, in children and in low and middle income settings, eosinophils may have important beneficial immunological actions. Furthermore, there is evidence that paediatric severe asthma may not be TH2 driven, phenotypes may be less stable than in adults, and adult biomarkers may be less useful. Children being evaluated for biologicals should undergo a protocolised assessment, because most paediatric asthma can be controlled with low dose inhaled corticosteroid if taken properly and regularly. For those with severe therapy resistant asthma, and refractory asthma which cannot be addressed, the two options if they have TH2 inflammation are omalizumab and mepolizumab. There is good evidence of efficacy for omalizumab, particularly in those with multiple asthma attacks, but only paediatric safety, not efficacy, data for mepolizumab. There is an urgent need for efficacy data in children, as well as data on biomarkers to guide therapy, if the right children are to be treated with these powerful new therapies.<\/jats:p>","DOI":"10.3390\/jcm9041237","type":"journal-article","created":{"date-parts":[[2020,4,29]],"date-time":"2020-04-29T01:29:15Z","timestamp":1588123755000},"page":"1237","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Which Child with Asthma is a Candidate for Biological Therapies?"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6756-9822","authenticated-orcid":false,"given":"Andrew","family":"Bush","sequence":"first","affiliation":[{"name":"Imperial College &amp; Royal Brompton Harefield NHS Foundation Trust, London SW\u00a3 dNP, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2020,4,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S0140-6736(17)30879-6","article-title":"After asthma\u2014redefining airways diseases","volume":"391","author":"Pavord","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1016\/S0140-6736(58)91385-0","article-title":"Treatment of chronic asthma with prednisolone; significance of eosinophils in the sputum","volume":"2","author":"Brown","year":"1958","journal-title":"Lancet"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1016\/S0140-6736(00)03496-6","article-title":"Effects of an interleukin-5 Blocking Monoclonal Antibody on Eosinophils, Airway Hyper-Responsiveness, and the Late Asthmatic Response","volume":"356","author":"Leckie","year":"2000","journal-title":"Lancet"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"985","DOI":"10.1056\/NEJMoa0805435","article-title":"Mepolizumab for Prednisone-Dependent Asthma with Sputum Eosinophilia","volume":"360","author":"Nair","year":"2009","journal-title":"N. 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