Table 3.

Main biological targeted treatments for severe asthma in children.

Drug (trade name), dosage	Mechanism of action	Suggested population	Adverse effects
APPROVED
Omalizumab (Xolair), s.c. injections every 2–4 wks, depending on body weight and IgE levels	Anti- IgE; binds Fc receptor of free circulating IgE and downloads IgE production	Age >6 yrs; 30 UI < IgE < 700 UI*; positive skin test or elevated specific IgE level toward a perennial	Anaphylaxis (~0.2% pts); monitor for helmintic infection
Mepolizumab (Nucala), 100 mg in pts aged 12 yrs or older (40 mg in pts aged 6–11 yrs) by s.c. injections every 4 wks	Anti- IL-5; binds circulating IL-5	Age >12 yrs; eosinophlic asthma	Zoster (rare); avoid if active helminithic infection
UNDER INVESTIGATION
Reslizumab (Cinqair), approved for adults (3 mg/kg by i.v. injections every 4 wks)	Anti- IL-5; binds circulating IL-5	Eosinophilic asthma	Anaphylaxis (rare); avoid if active helmintic infection
Dupilumab (Dupixent), approved for adults with atopic dermatitis	Anti- IL-4 and anti-IL-13; binds common α-subunit of receptor for IL-4 and IL-13	Eosinophlic asthma	Eosinophilia (rare); avoid live vaccines; avoid if active helmintic infection

IL, interleukin; i.v., intravenous; pt, patient; s.c., subcutaneous; wk, week; yr, year.

^*Upper limit varies according to body weight and regulatory authorities.