Preventation and Management of Infectious Diseases in Children Using Biological Response Modifiers

In this manuscript, it is aimed to summarize the infectious diseases in children treated with biological response modifying agents, and to determine the protective measures and the conditions to be considered in follow-up. Biological response modifying agents are medical molecules utilized in managing autoimmune and autoinflammatory diseases, exerting suppressive effects on the immune system through cytokines. The major targeted cytokines include tumor necrosis factor α; interleukin 6, 12, and 23; interleukin 1α and 1β receptors. Biological response modifying agents create a suppressive effect on these targets, making underlying disease remission more accessible. Patients using biological agents have an increased risk of opportunistic infections, particularly tuberculosis and viral infections. Although the risk varies by drug class, patients are generally at risk for mycobacterial (Mycobacterium tuberculosis and non-tuberculosis mycobacteria), viral (Herpes simplex virus, chickenpox virus, Epstein-Barr virus, Hepatitis B virus), and fungal (histoplasmozis, coccidioidomycosis) and other opportunistic infections. These infections can cause significant morbidity and mortality in immunosuppressive patients. Therefore, it is crucial for healthcare providers to closely monitor patients receiving biological agents for any signs or symptoms of infection. Additionally, appropriate prophylactic measures, such as vaccination against certain infectious agents or use of antimicrobial prophylaxis, may be considered to reduce the risk of opportunistic infections in these patients. Overall, the management of patients using biological agents requires a careful balance between controlling the underlying disease and minimizing the risk of infections.