Biologics in Allergic Disease: Molecular Mechanisms and Clinical Translation

The field of allergy and immunology has been transformed by the advent of biologic therapies targeting key molecular pathways involved in allergic disease. Despite regulatory approvals and expanding indications for agents such as anti-IgE, anti-IL-4/13, and anti-IL-5, ongoing challenges remain in optimizing patient selection, maximizing efficacy, and understanding the precise immunological mechanisms underlying therapeutic responses. Recent high-impact studies, such as OUtMATCH on omalizumab in food allergy, and real-world data on dupilumab across multiple indications, have illuminated both the promise and complexity of biologics. Simultaneously, atopic dermatitis has emerged as a major front of therapeutic innovation, driven by advances in dupilumab and promising clinical data on novel targets like IL-18. Yet persistent gaps exist regarding predictive biomarkers, combinational strategies, long-term safety, pediatric implications, and cost-effectiveness, particularly as therapies targeting TSLP gain widespread clinical adoption and novel pathways like IL-33 and IL-18 progress through late-stage clinical development. Furthermore, the translation of mechanistic insights into practice, as well as the harmonization of clinical and molecular endpoints, represents a major area of unmet need.This Research Topic aims to advance the integration of mechanistic understanding and clinical application of biologic therapies within allergic and atopic diseases. The objective is to explore how molecular biomarkers, disease endotyping, and the latest translational insights can guide the personalized use of biologics and contribute to better patient outcomes. Crucially, cutaneous manifestations such as atopic dermatitis present an invaluable translational medicine opportunity. Because of the accessibility of skin tissue for biopsies, skin indications increasingly serve as a gateway to probe the tissue-level biology of active immunological programs. Specific questions include optimizing biomarker-based patient selection, assessing combination approaches such as biologics with oral immunotherapy, and evaluating the effectiveness, safety, and accessibility of these treatments in diverse populations, including pediatric patients.To gather further insights into the mechanistic and clinical dimensions of biologic therapies in allergic and atopic conditions, we welcome articles addressing, but not limited to, the following themes:• Omalizumab mechanisms in food allergy: lessons from OUtMATCH.• Dupilumab and type 2 inflammation modulation across respiratory and cutaneous indications.• Atopic dermatitis as a translational gateway: using skin biopsies and tissue-level immunology to probe active immunological programs and therapeutic responses.• Biologic and oral immunotherapy combinations in clinical practice.• Predictive biomarkers for biologic response and disease endotyping.• Emerging and newly approved biologic targets in allergic disease, including clinical developments in TSLP, IL-33, and IL-18 pathways.• Real-world effectiveness data and post-marketing surveillance.• Pediatric applications and age-specific considerations.• Cost-effectiveness and treatment access considerations.Topic Editor, Charles Sinclair, is employed by Flagship Pioneering. All other Topic Editors declare no competing interests with regards to the Research Topic subject. Topic editors: Charles Sinclair, Bharat Vaidyanathan Source: https://www.frontiersin.org/research-topics/82976/biologics-in-allergic-disease-molecular-mechanisms-and-clinical-translation