Paradoxical inflammatory switches during biologic therapy: a mechanistic framework, clinical algorithm, and pediatric illustrations - Takeaways - MDSpire

Paradoxical inflammatory switches during biologic therapy: a mechanistic framework, clinical algorithm, and pediatric illustrations

  • By

  • Małgorzata Kowacka

  • Michał Dec

  • Hubert Arasiewicz

  • May 20, 2026

  • 0 min

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  • 1

    Paradoxical inflammatory reactions, or flip-flop phenomena, are complications of biologic therapies that can exacerbate underlying diseases.

  • 2

    These reactions arise from dynamic interactions between immune pathways, particularly Th1/Th17, Th2, and interferon–JAK/STAT axes.

  • 3

    A unified mechanistic framework for understanding flip-flop reactions is lacking, especially in pediatric populations.

  • 4

    The review proposes that these reactions reflect immune reprogramming due to selective immune pressure from biologic agents.

  • 5

    A practical diagnostic and therapeutic algorithm is introduced to aid in the recognition and management of flip-flop reactions.

Original Source(s)

Paradoxical inflammatory switches during biologic therapy: a mechanistic framework, clinical algorithm, and pediatric illustrations

  • by Małgorzata Kowacka, Michał Dec, Hubert Arasiewicz

  • May 20, 2026

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