Obesity and allergic diseases in children: childhood asthma as a model for integrated management
Sara Soldovieri, Grazia Fenu, Francesca Mori, Enrico Lombardi, Wanda Phipatanakul, Stefano Stagi, Mattia GiovanniniPurpose of review
Obesity and allergic diseases are highly prevalent in childhood. Asthma represents the best-characterized model in which excess adiposity modifies disease presentation, clinical burden, and treatment response. This review summarizes the recent pediatric evidence, with a focus on clinically actionable mechanisms, obesity-associated asthma phenotypes, and integrated management strategies.
Recent findings
Obesity-associated asthma is increasingly recognized as a heterogeneous disease phenotype rather than simple comorbidity. Recent pediatric data highlight altered oxidative stress, IL-6-related immunometabolic pathways, distinctive CD4+ T-cell transcriptional programs, and specific lung function patterns, such as dysanapsis and preserved ratio impaired spirometry (PRISm)-like physiology. These mechanisms suggest that persistent symptoms may reflect a combination of airway inflammation, altered lung mechanics, deconditioning, sleep-disordered breathing, and metabolic dysfunction. Interventional studies support structured aerobic training and anti-inflammatory dietary approaches as part of obesity management. Evidence on metabolic pharmacotherapy, including metformin and glucagon-like peptide-1 (GLP-1) receptor agonists, is emerging and suggests potential respiratory benefits, although current pediatric data remain largely observational and randomized asthma-specific trials are lacking.
Summary
In children, obesity should be considered a treatable trait requiring an integrated assessment of asthma control, lung mechanics, physical conditioning, sleep-disordered breathing, diet quality, and metabolic health. Current evidence supports multidisciplinary lifestyle interventions, whereas phenotype-driven pediatric therapeutic trials are needed to determine whether targeted metabolic, nutritional, exercise-based, digital, or pharmacological strategies can improve long-term respiratory outcomes.