Biologic Therapies Targeting Type-2 Inflammation in Pediatric Chronic Rhinosinusitis: Evidence, Extrapolation From Adults, and a Pediatric Research Agenda

Résumé fourni par la source

Pediatric chronic rhinosinusitis (CRS), particularly when complicated by nasal polyps (CRSwNP), spans a spectrum of age-dependent endotypes that challenge one-size-fits-all management. Emerging evidence – integrating pathology, multi-omic profiling, and real-world cohorts – indicates that younger children commonly exhibit non-type-2 (non-T2) inflammation driven by adenoidal disease and biofilm ecology, whereas adolescents increasingly manifest T2-high signatures that mirror adult CRSwNP. Within this context, biologic therapies targeting T2 pathways (anti-IL-4Rα, anti-IL-5/IL-5Rα, anti-IgE, anti-TSLP) have demonstrated multidomain benefits in adults and growing pediatric applicability, improving nasal polyp burden, congestion, olfaction, and steroid/surgery use when standard care is insufficient. Safety profiles across pediatric experience in related T2 diseases are generally favorable, with predictable and manageable adverse events; nonetheless, child-specific long-term data remain limited. This review synthesizes the pathophysiology and endotypes in childhood and adolescence, maps biomarker-guided selection, and summarizes evolving regulatory landscapes. Persistent gaps include the scarcity of randomized pediatric trials, incomplete validation of biomarkers and response criteria for children, and the need for cost-effectiveness analyses that reflect school participation and caregiver burden. Overall, biologics represent a meaningful advance for T2-high adolescent CRSwNP, enabling targeted, generally safe, steroid- and surgery-sparing strategies, while underscoring the imperative for dedicated pediatric trials, standardized endpoints, and robust pharmacovigilance to realize their full potential in comprehensive care.

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