Introduction: Biologic therapies have revolutionized the management of severe asthma in pediatrics, offering targeted options for specific inflammatory pathways. This study aimed to review the current indications and availability of biologics approved for pediatric use as of January 2025 and to analyze the clinical experience of a tertiary center in managing this condition. Methods: A comprehensive review of the biologics available for treating severe asthma in children was conducted, highlighting their indications and key characteristics. Additionally, a retrospective analysis was conducted on the experience of the Pediatric Severe Asthma Unit at the University Hospital of Navarra in utilizing these therapies between 2015 and 2025, with a focus on treatment distribution and reasons for switching biologics. Results: As of January 2025, the biologics available for pediatric use include omalizumab, mepolizumab, dupilumab, tezepelumab, and benralizumab, each with specific indications and different administration profiles. At the analyzed center, the distribution of biologics was as follows: omalizumab (27%), mepolizumab (27%), dupilumab (37%), and tezepelumab (9%). At the same center, the biologic distribution 10 years earlier was 100% omalizumab. Therapy changes and switches were primarily related to clinical response, posology, and comorbidities. Conclusions: This study emphasizes the importance of individualized management in pediatric severe asthma, based on continuous evaluation and appropriate biologic selection according to the clinical characteristics of each patient. It also highlights the need to develop specific guidelines for adjusting, switching, and discontinuing these therapies.

Background/Objectives: The emergence of biologic therapies has transformed the management of severe asthma, offering targeted treatments that improve symptom control and reduce exacerbations. However, taking a biologic solely based on the initial response may not be optimal. Clinicians must regularly reassess the suitability of the selected biologic, considering evolving patient characteristics and the growing availability of treatment options. This article aims to highlight the importance of individualized decision making in the long-term management of pediatric patients receiving biologic therapy, exploring the various reasons that may justify switching biologic treatment. Methods: We present a case to illustrate this approach: a 14-year-old adolescent girl with severe allergic asthma who initially received Omalizumab, achieving clinical, laboratory, and functional improvements. Despite this positive response, the patient reported low-level satisfaction due to the frequency of injections and hospital visits, leading to poor adherence. After a comprehensive reassessment, the treatment was switched to Tezepelumab. Results: Following the switch, the patient maintained stable disease control with a slight improvement in lung function, while adherence, satisfaction, and quality of life improved significantly. The number of hospital visits was reduced from 24 to 12 per year, and the number of injections decreased from 104 to 12 annually. The patient reported high-level satisfaction with the new treatment plan, and the economic burden of therapy was also substantially reduced. We present a table summarizing the essential and secondary factors to consider when initiating or switching biologic therapy. Conclusions: This case highlights the need to go beyond the traditional criteria, such as lack of efficacy and adverse reactions, when evaluating a switch in biologic therapy for pediatric asthma. Factors such as comorbidities, injection frequency and number, route of administration, and cost should also be considered, as they can directly influence adherence and the clinical outcomes in children and adolescents. As the therapeutic options expand, regular reassessment and personalized adjustments remain essential.