Allergen-specific immunotherapy, novel drugs and biologicals: hopes from the difficult-to-treat allergic child

Abstract

In the last decades, significant progresses have been reached in the management of atopic diseases in childhood. Several approaches have been proposed in patients affected by moderate-to-severe atopic diseases. Severe asthma and atopic dermatitis are poorly known with different underlying phenotypes and endotypes, and they may require further cares with biological therapies. Omalizumab, anti-IgE monoclonal antibody, is effective and safe in patients with atopic diseases, especially uncontrolled asthma and chronic urticaria. Anti-IL-5 drugs including mepolizumab, reslizumab and benralizumab are effective in resistant eosinophilic asthma. In patients with uncontrolled atopic dermatitis, dupilumab is of benefit. Allergen-specific immunotherapy (AIT) represents the only treatment attaining immunologic tolerance and sustaining improvement in symptoms. Both subcutaneous and sublingual immunotherapies are characterized by a short-term and a long-term efficacy, as demonstrated by a reduced immunologic reactivity after discontinuation. Component-resolved diagnosis has been found an essential diagnostic tool potentially able to increase the efficacy of AIT in polysensitized children, establishing a precise AIT prescription for patient genuinely sensitized to allergens. The future care of allergic diseases in childhood requires an individualized approach to achieve a patient-tailored therapy for difficult-to-treat atopic diseases.