A newly developed clinical prediction tool — or nomogram — could help physicians determine which children with allergic asthma and allergic rhinitis are most likely to respond to biologic therapies before treatment begins. The research addressed in the paper, “A Clinical Nomogram for Predicting Early Response to Biologics in Pediatric Allergic Asthma With Comorbid Allergic Rhinitis,” details a major challenge in pediatric allergy care: identifying likely responders to expensive targeted medications, such as omalizumab and dupilumab. The study was published in the Journal of Asthma and Allergy.
Researchers analyzed data from 246 children with moderate-to-severe allergic asthma and allergic rhinitis who received biologic therapy between 2021 and 2025. The goal was to create a practical, easy-to-use model capable of predicting whether patients would achieve meaningful clinical improvement within 16 weeks of treatment initiation.
The resulting nomogram demonstrated strong accuracy, investigators noted. Among the 246 children studied, approximately 66.7% were classified as early responders to biologic therapy. The model achieved a concordance index of 0.88 in the training group and 0.85 in the validation group, indicating excellent ability to distinguish likely responders from nonresponders. Calibration and decision curve analyses further showed that the tool could provide meaningful clinical value when making treatment decisions.
According to the study’s authors, allergic asthma and allergic rhinitis frequently occur together, with studies suggesting that up to 80% of children with allergic asthma also experience allergic rhinitis. Children affected by both conditions often face greater disease burden, more emergency health care visits and increased challenges achieving symptom control, they said.
Biologic therapies have transformed treatment options for severe allergic diseases, researchers noted, by targeting the underlying type 2 inflammatory pathways that drive symptoms. However, response rates vary significantly between patients, making treatment selection a critical clinical decision, they said.
Using statistical modeling techniques, investigators identified five baseline factors that independently predicted early response to biologic treatment:
- Fractional exhaled nitric oxide (FeNO)
- Blood eosinophil count (EOS)
- Total immunoglobulin E (IgE)
- Presence of atopic dermatitis (eczema)
- Body mass index (BMI)
The study indicated that higher levels of FeNO, eosinophils and IgE were associated with a greater likelihood of treatment success, reflecting the fact that biologics are specifically designed to target type 2 inflammatory pathways.
One of the study’s most notable findings was that children with atopic dermatitis were significantly more likely to respond to biologic therapy. Researchers found that patients exhibiting the so-called “atopic march” phenotype (characterized by asthma, allergic rhinitis and eczema) showed higher response rates than children with respiratory disease alone.
According to investigators, the shared inflammatory mechanisms underlying skin and airway diseases may explain why these children experience stronger benefits from therapies that target type 2 inflammation.
The study also found that higher BMI was associated with lower treatment effectiveness. Researchers suggested obesity may contribute to alternative inflammatory pathways that are less responsive to currently available biologic therapies. This finding could help clinicians better manage expectations and emphasize weight-management strategies as part of comprehensive asthma care, they wrote.
The authors said they believe the nomogram could support precision medicine by helping physicians identify potential “super-responders” before therapy begins. For patients with a low predicted probability of success, investigators encouraged clinicians to consider alternative approaches, such as allergen immunotherapy or additional diagnostic evaluation.
Although the research was conducted at a single center and focused on short-term outcomes, investigators said the tool represents an important step toward more personalized treatment strategies in pediatric allergy and asthma care. They said future multicenter studies will be needed to validate the findings and assess long-term outcomes.
