Vivian P Hernandez-Trujillo, MD

Management of chronic inflammatory diseases like 

 can involve a variety of approaches to treatment, with non-steroidal agents often being considered by caregivers who are wary of steroidal drugs.

 following a clinical forum, Vivian Hernandez-Trujillo, MD, the medical director for the Division of Allergy and Immunology at Nicklaus Children's Hospital, touched on atopic dermatitis management approaches. Hernandez-Trujillo was first asked how the shift from steroid-dominant to targeted and nonsteroidal therapies changed her approach to managing atopic dermatitis in pediatric and adult patients.

Management of Pediatric Atopic Dermatitis in Contemporary Settings, With Vivian Hernandez-Trujillo, MD

“I think that now we have so many treatment options that are safer, and I think that's really the key is having options that are safe and that work well,” Hernandez-Trujillo said. “I think that's really the greatest shift that's happened, that we don't have to necessarily just use topical steroids on everybody.”

Hernandez-Trujillo was also asked what she believes effective comanagement looks like in her practice, and how it influences diagnostic accuracy and atopic dermatitis treatment success.

“It really enhances the success, and it's the best for the patients,” she explained. “I think that when specialists work together, and it was definitely discussed during the forum…It's having a mutual respect and understanding. One person may be the primary treatment physician, but then bringing in the rest of the team who have a lot of insights [is helpful]. We're all coming at it from different angles, and I think that's only to the benefit of the patients.”

The conversation highlighted the evolution of atopic dermatitis treatment, emphasizing safer options beyond topical steroids. Hernandez-Trujillo expressed her belief in persistent advocacy in prior authorizations and acknowledged access issues, such as those in urban areas.

“The reality is, we can do that, but number one, we're limited as specialists,” she explained. “And number two, there's only so much that we can do. That can't take up the majority of our day. I think the advocating piece is very important. So really, using the information that we have, and having the families work with us on that, [is key]. If I've really fought for the family, and I've had, let's say, a peer-to-peer, and it's still not going through, I tell the families, ‘I need you to call it. This is partly your responsibility, too. I'm trying to do what's best for you, but I'm reaching a roadblock.’”

Chronic disease management involves consistent routines, such as moisturizing after showers and keeping medications accessible. The importance of proactive care over reactive measures was underscored by Hernandez-Trujillo, especially for pediatric patients, to prevent long-term effects and flare-ups.

In this summary, the quotes used were edited for the purposes of clarity.

Hernandez-Trujillo has reported serving as an advisor for CSL, Takeda, Kaleo, Genentech, Sanofi/Regeneron, Pfizer, Bayer, ARS, Bryn, Stallergens/Greer, and SMPA/Enzyvant; as a speaker for CSL, Takeda, Kaleo, and Genentech; and as a consultant for Pharming.

Gallagher K, Halperin-Goldstein S, Paller AS. New treatments in atopic dermatitis update. Ann Allergy Asthma Immunol. 2025 Jun 23:S1081-1206(25)00312-6. 

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The interview highlights the evolution of atopic dermatitis treatment, emphasizing options beyond topical steroids.

Peanut Allergy Rates Plummet 10 Years After AAP Early Introduction Guidelines

sharp decline in peanut and food allergy prevalence

, but experts say the real work is just beginning.

A decade after the American Academy of Pediatrics (AAP) endorsed early peanut introduction, new real-world data suggest those recommendations are paying off.

A study led by David Hill, MD, PhD, and colleagues at the Children’s Hospital of Philadelphia analyzed data from more than 85,000 children across nearly 50 pediatric practices and found a 27% drop in 

 following the 2015 early introduction guidelines (

 <.0001), along with a 43% decrease after the 2017 addendum (

 <.0001). Rates of any IgE-mediated food allergy also fell by more than a third, offering promise for food allergy prevention.

, provide the first large-scale evidence that national policy changes inspired by the landmark LEAP trial have translated into measurable real-world benefits. The LEAP study, published in 2015, demonstrated that infants who were introduced to peanuts early and kept them in their diet were significantly less likely to develop a peanut allergy later in life.

“An outstanding question after these guidelines was whether we are actually seeing meaningful changes in the prevalence of food allergy, and so that is why we did this study,” Stanislaw J. Gabryszewski, MD, PhD, a trial investigator of the recent analysis and an attending physician at Children’s Hospital of Philadelphia, told 

. “Reassuringly, we did see declines in the rates of both peanut and just overall food allergy prevalence.”

Still, despite encouraging data, experts say implementation remains uneven. Previous surveys show that fewer than 1 in 3 pediatricians, and only 17% of caregivers, fully follow the latest recommendations.

Ruchi Gupta, MD, MPH, director of the Center for Food Allergy & Asthma Research at Northwestern University Feinberg School of Medicine, said the declining rates are a promising signal, even if cause and effect cannot yet be confirmed. She had written a commentary on Hill and colleagues’ paper, praising the team for using AAP’s harmonized electronic health record database to capture real-time, practice-based trends in food allergy prevention.

. She added that it is exciting that the analysis showed a lower incidence of peanut allergy in children born after the guidelines were introduced.

For clinicians, the shift in food allergy prevention has been dramatic. “It’s an everyday conversation,” said Vivian P. Hernandez-Trujillo, MD, a pediatric allergist at Nicklaus Children’s Hospital. “I have it multiple times, especially with parents of young children, because it has just swung so much like in the last 10 years.”

Looking ahead, investigators are expanding their focus beyond peanuts. Gupta’s team is conducting a randomized controlled trial of 1800 infants to determine whether early introduction of other common allergens—such as milk, egg, tree nuts, and sesame—can further reduce food allergy rates.

While the peanut allergy decline marks a major step forward, Gupta emphasized that guideline adoption takes time. “Guidelines take a good 10 to 20 years sometimes to go from publication to actually getting into the general public and having an impact. Having a change happen so quickly is great,” she said. “What I suspect is [that] it was a dip, which is great, but we may see some bouncing around until it stabilizes and actually truly shows that we can decrease and turn the tide of peanut allergy in the US.”

 Northwestern University Feinberg School of Medicine

Relevant disclosures include Horizon Therapeutics plc for Gabryszewski; Kaleo, Genetech, and Regeneron Healthcare Solutions for Gupta; and Kaleo for Hernandez-Trujillo.

Derman C. Early Peanut Introduction Guidelines Linked to Drop in Food Allergy Rates. HCPLive. October 20, 2025. 

https://www.hcplive.com/view/early-peanut-introduction-guidelines-linked-drop-food-allergy-rates

Gabryszewski SJ, Dudley J, Faerber JA, et al. Guidelines for Early Food Introduction and Patterns of Food Allergy. Pediatrics. Published online October 20, 2025. 

Fleischer DM, Sicherer S, Greenhawt M, et al. Consensus Communication on Early Peanut Introduction and the Prevention of Peanut Allergy in High-risk Infants. Pediatrics. 2015;136(3):600-604.

 doi:https://doi.org/10.1542/peds.2015-2394

Du Toit G, Sayre PH, Roberts G, et al. Effect of Avoidance on Peanut Allergy after Early Peanut Consumption. N Engl J Med. 2016;374(15):1435-1443. 

Gupta RS, Bilaver LA, Togias A. Encouraging Trends in Peanut Allergy Prevention: Real-World Impact of Prevention Guidelines. 

New data show peanut allergy rates have dropped sharply since early introduction guidelines, reducing 27% and 43% after the 2015 and 2017 guidelines, respectively.


Vivian P Hernandez-Trujillo, MD

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