Jay Lieberman, MD, from University of Tennessee

Jay Lieberman, MD

What is the Role of Immunology in Atopic Dermatitis Care? With Jay Lieberman, MD

Jay A. Lieberman, MD, a professor at the University of Tennessee Health Science Center, highlighted the increasingly collaborative nature of atopic dermatitis care during a discussion at the 

2026 Revolutionizing Atopic Dermatitis (RAD) Conference

, with the ways in which advances in immunology and systemic therapies are reshaping the relationship between dermatology and allergy/immunology being notable takeaways.

In discussion with the editorial team at 

, Lieberman described the historic divide between the 2 specialties as having narrowed considerably as the understanding of atopic dermatitis has shifted over time. With the emergence of biologics and targeted systemic medications for patients, both dermatologists and allergists are now approaching the disease through an immunologic lens. Lieberman explained while dermatologists have traditionally focused on cutaneous manifestations, the increasing emphasis on immune pathways and systemic disease has brought the specialties closer together.

“I think as we get these newer therapies and these systemic agents, and we learn about all these immunologic aspects of atopic dermatitis, dermatologists are at the forefront of this now,” Lieberman said. “And I think that difference in allergy and dermatology is really decreasing over time.”

A key theme of Lieberman’s discussion was the importance of considering the broader spectrum of comorbidities known to commonaly accompany atopic dermatitis. He encouraged clinicians to think beyond the skin and evaluate patients for conditions linked to the disease impacting treatment decisions. As more drugs demonstrate efficacy across multiple atopic and inflammatory diseases, Lieberman stated, understanding a patient’s complete disease burden has become increasingly necessary.

In his interview, Lieberman also reflected on how dramatically the therapeutic landscape has shifted over the course of his career. When he began training, treatment options for moderate-to-severe atopic dermatitis were described as limited, with few systemic treatments being accessible. Today, clinicians have access to a growing number of targeted agents designed to address the underlying immunologic mechanisms of disease, fundamentally changing how atopic dermatitis is managed.

From an allergy and immunology perspective, Lieberman described immune system biology as having long been central to specialty training and clinical practice. However, Lieberman highlighted the evolution of modern dermatology in a similarly manner, with today's dermatologists increasingly functioning as “immunodermatologists” as they incorporate complex immunologic concepts into patient care. In other words, Lieberman sees fewer differences between the specialties than in the past.

Disclosures: Lieberman has previously been associated with Novartis Pharmaceuticals, ABBVIE, Genentech, Aquestive Therapeutics.

Lieberman J, Hawkes J. Connecting AD to Other Dermatologic Disorders and Related Comorbidities. Session presented at: 2026 Revolutionizing Atopic Dermatitis Conference; June 17-19, 2026; Nashville, TN.

Lieberman J. How Should Clinicians Address the Link Between Atopic Dermatitis and Allergy? HCPLive. June 18, 2026. 

https://www.hcplive.com/view/how-clinicians-address-link-between-atopic-dermatitis-allergy-

Videos

At RAD2026, Lieberman notes advances in immunology and systemic therapies that are reshaping the link between dermatology and allergy/immunology.


How Should Clinicians Address the Link Between Atopic Dermatitis and Allergy? With Jay Lieberman, MD

Jay A. Lieberman, MD, professor at the University of Tennessee Health Science Center, noted the value of viewing atopic dermatitis within the broader context of allergic disease during his presentation, ‘Connecting AD to Other Dermatologic Disorders and Related Comorbidities,’ at the 

team, Lieberman emphasized that while dermatologists and allergists share the same goal of improving patient outcomes and quality of life, those working in allergy often look at atopic dermatitis through a wider lens. Instead of aiming only toward the skin manifestations of disease, Lieberman noted many of those with atopic dermatitis also report other atopic conditions, including asthma, allergic rhinitis, and food allergies.

As a result, treatment decisions are often guided by a patient's broader allergic disease profile and the opportunity to address multiple conditions simultaneously. A major theme of Lieberman’s discussion centered on the growing evidence supporting early intervention in atopic disease. He pointed to ongoing research evaluating whether aggressive management of eczema early in life, including the use of emollients and low-dose topical corticosteroids, may help restore skin barrier function and alter the trajectory of disease development.

Investigators are increasingly examining whether such strategies could reduce not only the long-term burden of atopic dermatitis but also the risk of developing additional allergic conditions. Lieberman also pointed to advances in food allergy prevention as another example of how early intervention is reshaping clinical practice. The growing amount of literature supporting early introduction of allergenic foods has demonstrated that proactive management can reduce food allergy risk, he noted, reinforcing the broader concept that early action may influence the progression of atopic disease.

The discussion additionally highlighted the rapidly evolving therapeutic landscape in atopic dermatitis. With an expanding number of biologics and systemic therapies now available, clinicians are faced with more opportunities to personalize treatment than ever before. Lieberman noted that evaluating a patient’s comorbid conditions has become increasingly important when selecting therapy, as certain treatments may provide benefits across multiple atopic diseases.

Overall, Lieberman underscored the need for a comprehensive, patient-centered approach to disease management. As understanding of the connections between eczema, food allergy, asthma, and other allergic conditions continues to grow, clinicians may be better positioned to intervene earlier and to tailor their treatment strategies more effectively.

Lieberman, spoke at RAD 2026 about highlights from his session, ‘Connecting AD to Other Dermatologic Disorders and Related Comorbidities.'

How Should Clinicians Address the Link Between Atopic Dermatitis and Allergy?

Expanding Epinephrine Options to Reduce Barriers, Improve Early Use

Part 4 of the special report explores one of the most rapidly evolving areas in 

 care: the expanding range of epinephrine delivery options and their potential to overcome long-standing barriers to timely treatment. Panelists reviewed both currently available products and emerging alternatives that may reshape how patients carry and use epinephrine.

The discussion began with a review of injectable options. In the United States, epinephrine autoinjectors are available in 0.1 mg, 0.15 mg, and 0.3 mg doses, while a 0.5 mg autoinjector is available in Europe but not yet in the US. Golden noted that this raises concerns about underdosing in larger adults and underscores the importance of promptly administering a second 0.3 mg dose if symptoms do not improve. Using weight-based dosing (0.01 mg/kg), a 0.3 mg dose is theoretically appropriate for a patient weighing approximately 30 kg (66 pounds), highlighting the need for repeat dosing in adolescents and adults with severe reactions.

Both experts emphasized that syringe-and-needle intramuscular epinephrine remains appropriate in healthcare settings, where dosing can be precisely tailored, even though autoinjectors achieve faster absorption in pharmacokinetic studies. However, many of the persistent gaps in anaphylaxis outcomes stem not from pharmacology but from human factors, including fear of needles, reluctance to carry devices, uncertainty about diagnosis, and hesitation to use epinephrine early.

The panel highlighted the significance of newly approved and emerging non-injectable options. Golden described the first FDA-approved intranasal epinephrine spray (neffy), which has been on the market for over a year.1 Because placebo-controlled anaphylaxis trials are not feasible, approval relied on pharmacokinetic data demonstrating plasma epinephrine levels comparable to existing intramuscular products.2 The nasal spray falls within the therapeutic range between manual intramuscular injection and autoinjectors, and early real-world experience has been encouraging.

The experts discussed additional products in development, including other nasal formulations and a sublingual oral film (Anaphylm) using a prodrug approach to overcome epinephrine’s absorption challenges.3 Lieberman noted that many patients strongly prefer oral medications, making a sublingual option particularly appealing if efficacy is maintained. Newer formulations may also offer practical benefits such as longer shelf life and greater temperature stability.

In closing, Golden and Lieberman returned to the core message of the entire series. Improving anaphylaxis outcomes requires earlier epinephrine use, fewer barriers to administration, and abandoning outdated reliance on antihistamines and corticosteroids in acute care. As Lieberman summarized succinctly: “Epinephrine, epinephrine. Let's stop using steroids for anaphylaxis, and let's use epinephrine early on and get rid of barriers to use.”

, a board certified allergist/immunologist from Cleveland Clinic Children’s Hospital.

, an associate professor from the College of Medicine - Memphis, department of pediatrics, and division of peds pulmonology at the University of Tennessee Health Science Center. He is also a practicing physician at LeBonheur Children’s Hospital, current chair of the food allergy committee for the American College of Allergy, Asthma, and Immunology, and is co-chair of the Joint Task Force for Practice Parameters.

, associate professor of medicine (part-time) at Johns Hopkins, co-chair of the Joint Task Force on Practice Parameters for allergy, and division chief for allergy-immunology at Sinai Hospital of Baltimore and Franklin Square Hospital in Baltimore.

Disclosures include Novartis Pharmaceuticals, Regeneron Pharmaceuticals, BioCryst, GlaxoSmithKline, Amgen, GENZYME Corporation, AstraZeneca Pharmaceuticals, and LEO Pharma for Schroer; Novartis Pharmaceuticals, ABBVIE, Genentech, Aquestive Therapeutics for Lieberman; and Phadia US and Genentech USA for Golden.

Greenhawt M, Schroer B, Kraft C, et al. One Year Later: How Intranasal Epinephrine Is Changing Emergency Allergy Treatment. HCPLive. Published on August 8, 2025. Accessed on February 10, 2026. 

https://join.hcplive.com/view/one-year-later-how-intranasal-epinephrine-is-changing-emergency-allergy-treatment

Smith T. FDA Approves Epinephrine Nasal Spray for Emergency Treatment of Allergic Reactions. HCPLive. Published on August 9, 2024. Accessed on February 10, 2026. 

https://www.hcplive.com/view/fda-approves-epinephrine-nasal-spray-for-emergency-treatment-of-allergic-reactions

Golden D. Anaphylm Remains Promising for Anaphylaxis Despite FDA CRL, With David Golden, MD. HCPLive. Published on February 3, 2026. Accessed on February 10, 2026. 

https://www.hcplive.com/view/anaphylm-remains-promising-anaphylaxis-despite-fda-crl-david-golden-md

Part 4 highlights how expanding epinephrine delivery options can reduce barriers, support earlier administration, and improve real-world anaphylaxis outcomes.

Recognizing, Managing Anaphylaxis in Infants

Part 3 of the special report turns to an increasingly important and nuanced topic: identifying and managing 

in infants. As early food introduction becomes standard practice, clinicians are encountering allergic reactions at younger ages, making infant-specific guidance more clinically relevant than ever.

Jay Lieberman, MD, opened the discussion by noting that while most reactions seen during early food introduction are mild and not anaphylaxis, the overall number of reactions has increased. This naturally raises the likelihood of encountering true anaphylaxis in infants. Unlike older children or adults, infants cannot verbalize classic symptoms such as throat tightness or oral itching, which complicates recognition and increases reliance on observable signs and caregiver intuition.

Both Lieberman and David Golden, MD, emphasized that infant anaphylaxis often presents through behavioral and nonspecific symptoms. These can include unusual or inconsolable fussiness, lethargy, persistent crying, tongue thrusting, ear pulling, and changes in appearance that parents frequently recognize before clinicians do. Although the current practice parameters still recommend using standard anaphylaxis criteria, the 2024 update acknowledges that it is reasonable to incorporate these infant-specific behavioral cues when assessing reactions in this age group.

From a management standpoint, the experts stressed that treatment principles in infants are fundamentally the same as in older patients. Epinephrine remains first-line therapy, and hesitation around dosing should not delay treatment. Golden highlighted that although autoinjectors are labeled for children above certain weight thresholds, the guidelines clearly support using whatever epinephrine dose is available, even in very small infants, because treating anaphylaxis takes precedence over concerns about relative dosing.

Lieberman reinforced this point succinctly: if a 0.1 mg device is available, use it; if only a 0.15 mg device is on hand, use that instead. Fear of “overdosing” should never prevent timely epinephrine administration in an infant with a concerning reaction.

The panel also noted emerging efforts to align updated infant recognition criteria, newer epinephrine delivery options, and post-epinephrine observation guidance into revised anaphylaxis action plans. The discussion concluded with a broader reminder that education is central to infant anaphylaxis care. Prescribing epinephrine alone is insufficient; clinicians must also teach caregivers how to recognize visual and auditory signs of systemic allergic reactions and when—and how—to act.

Golden DBK, Wang J, Waserman S, et al. Anaphylaxis: A 2023 practice parameter update. 

In this segment, experts emphasize the importance of giving an infant experiencing anaphylaxis epinephrine at whatever dose may be available rather than delaying treatment.


Jay Lieberman, MD

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