Immediate and delayed hypersensitivity to biologicals in children—A practical approach: An EAACI task force report

In the era of precision medicine, biologicals demonstrate how therapies can be personalized and directed against new targets. This type of therapy includes different molecules such as growth factors, immune modulators, vaccines, and monoclonal antibodies (mAbs). In recent years, biologicals have been increasingly developed and authorized, although their use in children is limited compared to that in adults, due to the complexity of the pharmacokinetics and pharmacodynamics of the involved proteins, as well as other factors, such as regulations governing clinical trials. Regardless, biologicals are used with efficacy in children to treat various diseases, including oncological, hematological, atopic, and rheumatological diseases. In parallel with the increased use of biologicals, there has been an increase in the unwanted effects of these agents. This paper aims to provide physicians with a practical approach to differentiate between the types of reactions to biologicals in children, especially mAbs, based on the frequency of use, for a comprehensive allergy workup. Starting from a clinical case (i.e., phenotype), specific biomarkers of the involved molecular mechanism (i.e., endotype) are described, providing the reader with currently known instruments to guide the diagnosis. Finally, practical limitations, preventive measures, and unmet needs were discussed by a panel of experts.

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Publication Details

Journal
Pediatric Allergy and Immunology
Published
2026-04-01
DOI
https://doi.org/10.1111/pai.70277
Primary Topic
Drug-Induced Adverse Reactions
Type
article
Field-Weighted Citation Impact
0.00

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article

Immediate and delayed hypersensitivity to biologicals in children—A practical approach: An EAACI task force report

Mattia Giovannini, Sevim Bavbek, Marina Labella, Ekaterina Khaleva et al.
Pediatric Allergy and Immunology
Drug-Induced Adverse Reactions
article

Immediate and delayed hypersensitivity to biologicals in children—A practical approach: An EAACI task force report

Mattia Giovannini, Sevim Bavbek, Marina Labella, Ekaterina Khaleva, Luis Moral, Carmen Riggioni, Leticia De Las Vecillas, S. Arasi, Jean‐Christoph Caubet, Sophia Tsabouri, Vito Sabato, Annick Barbaud, Marina Atanaskovic‐Markovic, Francesca Mori
article en

Abstract

In the era of precision medicine, biologicals demonstrate how therapies can be personalized and directed against new targets. This type of therapy includes different molecules such as growth factors, immune modulators, vaccines, and monoclonal antibodies (mAbs). In recent years, biologicals have been increasingly developed and authorized, although their use in children is limited compared to that in adults, due to the complexity of the pharmacokinetics and pharmacodynamics of the involved proteins, as well as other factors, such as regulations governing clinical trials. Regardless, biologicals are used with efficacy in children to treat various diseases, including oncological, hematological, atopic, and rheumatological diseases. In parallel with the increased use of biologicals, there has been an increase in the unwanted effects of these agents. This paper aims to provide physicians with a practical approach to differentiate between the types of reactions to biologicals in children, especially mAbs, based on the frequency of use, for a comprehensive allergy workup. Starting from a clinical case (i.e., phenotype), specific biomarkers of the involved molecular mechanism (i.e., endotype) are described, providing the reader with currently known instruments to guide the diagnosis. Finally, practical limitations, preventive measures, and unmet needs were discussed by a panel of experts.

Pediatric Allergy and ImmunologyVol. 37(4)
University of Antwerp (BE), Ankara University (TR), Inserm (FR), University of Toronto (CA), University of Ioannina (GR), Hospital Universitario La Paz (ES), Royal Hampshire County Hospital (GB), Sorbonne Université (FR), University of Belgrade (RS), Antwerp University Hospital (BE), Hospital La Paz Institute for Health Research (ES), University Hospital of Geneva (CH), Hospital Regional Universitario de Málaga (ES), Meyer Children's Hospital (IT), Province of Antwerp (BE), Bambino Gesù Children's Hospital (IT), Institut Pierre Louis d‘Épidémiologie et de Santé Publique (FR), Hospital General Universitario de Alicante Doctor Balmis (ES), SickKids Foundation (CA), University Children's Hospital, Belgrade (RS), Istituti di Ricovero e Cura a Carattere Scientifico (IT), Instituto de Investigación Biomédica de Málaga (ES), Hôpital Tenon (FR), University of Southampton (GB), Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL) (ES), University of Florence (IT)
European Academy of Allergy and Clinical Immunology
Openalex Percentile: Top 28%
Drug-Induced Adverse Reactions
DOIOpen Access PDFOpenAlex
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