10 - The Wafer: Everyone likes damage reduction. Things like orbitals or infamy are a real blessing in this game. But one of the best remains The Wafer to me. Getting only half a heart per hit makes the game much less stressful, especially in the latter stages where everything recks you. Essentially gives you double health.
8 - Tech X: Giant laser ring tears, that deal huge damage. Infinite range, piercing and spectral tears at once. It's a charge shot, it has huge damage and a huge hitbox, and it synergises really well. What do you want more in the world?
7 - Holy Mantle: Did I say Wafer was the best? Pff, this guy is nothing to Holy Mantle. Makes The Lost somewhat playable (that's an achievement on its own), makes sacrifice room completely free to enter, and more importantly gives you one free hit per room. If that's not a blessing, I don't know what is.
6 - Pyromaniac: Explosion immunity. No, I'm sorry, explosions heal you. If you have any explosive tear item like Ipecac or a Foetus item, you're basically invincible. Not to mention that Mom and Satan are jokes now. When you have an item so good that it nullifies all the downsides of my 2nd and 3rd most hated items in the game, you know you're holding on to a pretty good item here.
4 - Sacred Heart: This guy gives you everything. And I mean everything. Stats up, health, homing shots... But why do you never show up dude? Who even goes to Angel Rooms? Devil Deals are too tempting man!
3 - Godhead: I've heard this guy is good. I don't know.
2 - Mom's Knife: A crazy good item, with all the damage up you could ever need. Such a shame I can't damn aim with this thing.
1 - Brimstone: I mean.... Giant laser of doom that kills everyone. If I asked a 6 yo what would be the best weapon in a game, they would describe me that.