Severe asthma in children is a chronic, heterogeneous condition that significantly impacts quality of life and poses management challenges. The introduction of biological therapies has transformed treatment paradigms, offering targeted interventions for patients with specific phenotypes. This review provides an overview of the current evidence on biologic therapies approved for pediatric severe asthma, including omalizumab, mepolizumab, benralizumab, and dupilumab. We discuss their mechanisms of action, pivotal clinical trials, real-world data, and practical considerations for use. A comprehensive literature search was performed using PubMed, Embase, and major conference proceedings up to May 2025. We also examine emerging biologic agents targeting upstream pathways, such as tezepelumab and anti-IL-33 therapies, and explore the concept of asthma remission and its implications for long-term disease trajectories. Biologics represent a significant advancement in pediatric asthma management, enabling for tailored treatments based on underlying pathophysiology. However, challenges persist in optimizing patient selection, enhancing access, and comprehending long-term outcomes. Future research should focus on early intervention strategies, cost-effectiveness analyses, and the potential for disease-modifying effects in children.
Indolfi et al. (Mon,) studied this question.