Exploring the Potential Benefits of Biologic Therapies Beyond Respiratory Allergy

Severe pediatric asthma is a heterogeneous inflammatory disease that is most commonly driven by type 2 (T2) inflammation. Because respiratory viral infections are the leading triggers of asthma exacerbations in children, this review examines the effects of biologic therapies on infection-related outcomes and antiviral immune function, beyond their established role in asthma control. We conducted a structured narrative review of literature published from January 2000 through February 2026 using PubMed/MEDLINE, EMBASE, Scopus, and the Cochrane Library databases. Studies evaluating infection-related outcomes and immune effects of biologic therapies in pediatric asthma were analyzed. Available evidence consistently indicates that biologics have favorable infectious safety profiles without increasing the risk of serious or opportunistic infections. Anti-IgE therapy (omalizumab) showed the strongest evidence of direct immunomodulatory effects, including restoration of interferon-mediated antiviral responses and reduction of virus-triggered asthma exacerbations. Anti-IL-5 and anti-IL-5 receptor therapies have corticosteroid-sparing effects and preserve immune competence despite eosinophil depletion. Dupilumab and tezepelumab similarly provide sustained efficacy and stable safety profiles without increasing infectious burden. Real-world evidence from the COVID-19 pandemic further indicates that biologic-treated children do not have greater susceptibility to SARS-CoV-2 infection or more severe disease. Overall, biologic therapies appear to provide targeted immunomodulation rather than broad immunosuppression, preserving host defense while controlling severe pediatric asthma. These findings suggest that biologic therapies may positively influence immune competence beyond asthma control, with implications for infection susceptibility and antiviral defense. Further prospective pediatric studies with standardized endpoints and long-term follow-up are needed to define their immunological impact and optimize precision-medicine strategies.