Ushakova Olga¹, Mikhailov Stepan², Kuznetsova Alina³, Egorov Timofey⁴, Ivanova Darya⁵,Pavlov Nikita⁶, Sidorova Viktoria⁷, Frolov Artem⁸, Volkova Elizaveta⁹
ABSTRACT:
Bronchial asthma in early childhood presents a significant diagnostic and therapeutic challenge due to its heterogeneous nature, overlapping clinical features with viral wheezing, and the dynamic maturation of the immune system during the first years of life. Immunologically, pediatric asthma is characterized by an imbalance between Th1 and Th2 immune responses, elevated levels of eosinophils, and increased production of IgE and interleukins such as IL-4, IL-5, and IL-13. These immune signatures, often detectable even before clinical symptoms fully develop, offer potential for early diagnosis and risk stratification. Recent advances in immunophenotyping and biomarker discovery—such as blood eosinophil counts, exhaled nitric oxide, and serum periostin—are enhancing the identification of asthma-prone children and enabling a shift toward preventative intervention. Early-life environmental exposures, including allergens, viral infections, and microbiome dysbiosis, critically shape immune development and asthma trajectory, providing actionable targets for modulation. Management strategies increasingly rely on stratified approaches that incorporate immunological profiles into treatment decisions. Inhaled corticosteroids remain the cornerstone of therapy; however, novel immunomodulatory agents, including biologics targeting IL-5 and IgE, are being evaluated for use in severe pediatric asthma. The integration of immunological data into clinical practice also supports tailored immunoprophylaxis strategies, such as allergen immunotherapy and microbiota-based interventions. Improved understanding of early immune dysregulation and its long-term impact on airway remodeling and responsiveness is essential to preventing chronic disease progression. As asthma remains one of the most prevalent chronic diseases in childhood, immunologically informed diagnostic and management pathways hold promise for improving outcomes through precision pediatric care.