Featured: Jamie Blum, PhD (bottom left), Jose Clemente, PhD (top right), and Susanne Brix-Pedersen (bottom right)

 care has long focused on management after sensitization, with efforts on desensitization and forms of epinephrine for anaphylaxis. The ultimate question is: can we prevent allergy before it begins?

Currently, food allergy management relies on 3 approaches: avoidance, medications, and immunotherapy. For emergencies, patients can carry epinephrine. Until recently, allergies could only be managed, not prevented altogether, but now new research shows the possibility of preventing food allergies in the critical early-life window.

“If a child is either sensitized to a food allergen or…theoretically allergic to a food allergen… we can actually get small amounts of the food into their diet without actually stimulating their immune allergic response,” Nicole Chase, MD, an allergist/immunologist at St. Paul Allergy & Asthma, told 

. “We actually can sometimes reverse this process.”

She referenced a study led by Julie E. M. Upton, MD, MPH, from the Food Allergy and Anaphylaxis Program at the Hospital for Sick Children in Toronto, which showed that if you can get 30 mg of peanut protein into a kid’s diet, it can help promote tolerance.2 The data indicate that early food introduction can be safe in children under 35 months of age, but Chase suspects 18 months is probably the right number. The study found that very low-dose oral immunotherapy (VLOIT), with a goal to slowly escalate to a 30 mg per nut maintenance dose, led to significant gains in reaction threshold by 18 months, with mean tolerated doses reaching 1000 mg.

“This is why for parents and families where there's been some type of reaction to foods, it's so important to get those kids in to see an allergist right away,” she added.

However, Upton and colleagues’ study included children already allergic to 2 – 5 nuts, so this research did not provide insight into food allergy prevention before sensitization.

Previously, the landmark Learning Early About Peanut Allergy (LEAP) trial showed early peanut introduction can protect high-risk infants from developing peanut allergies.

By 5 years old, 3.2% of the peanut consumption group vs 17.2% of the avoidance group developed a peanut allergy, representing an approximately 80% relative risk reduction in peanut-exposed children.

The LEAP study informed early food introduction guidelines in 2015 for high-risk infants and the 2017 addendum guidelines which extended the recommendations to moderate-to-high-risk infants.

A study published October 2025 reported a 27% decline in peanut allergy rates following the 2015 early introduction guidelines (0.67% vs 0.92%; 

New data continue to drive momentum in food allergy prevention before sensitization, suggesting risk may be modified at the microbiota level.

Vaginal Seeding Linked to Early Microbiome Changes and Food Sensitization

, presented at the 2026 American Academy of Allergy, Asthma, & Immunology (AAAAI) meeting in Philadelphia, suggest vaginal seeding in cesarean-delivered infants can partially modify early gut microbiome development and may influence food allergen sensitization at 12 months.

 The double-blind, placebo-controlled randomized study evaluated whether exposure to maternal vaginal microbiota at birth could alter allergy risk among infants at high risk for allergic disease.

The trial included 39 vaginally delivered infants, 37 cesarean-delivered infants assigned to placebo seeding, and 37 cesarean-delivered infants who underwent vaginal microbial transfer. Seeding involved swabbing newborns with gauze incubated in the maternal vagina before delivery. Shotgun metagenomic sequencing confirmed microbial transfer, with enrichment of Lactobacillus immediately after birth in seeded infants (

At 3 months, microbiome similarity to vaginally delivered infants was greater among seeded infants, although the effect was partial (similarity indices 0.876 ± 0.07 vs 0.9 ± 0.06; 

 =.169) and diminished over time. By 12 months, global microbiome composition differences were no longer apparent.

Maternal vaginal microbiome composition was not associated with food sensitization at 12 months (

 =.86). However, specific infant gut microbes were linked to sensitization, including 

 with egg, milk, and peanut sensitization (

 =.013, .032, and .006, respectively). Seeded infants exhibited lower levels of 

 and, when microbial transfer was effective, lower sensitization rates than placebo.

“It's important to remember that the ACTIVATE trial is a pilot trial,” Jose Clemente, PhD, associate professor of genetics and genomics and immunology at the Icahn School of Medicine at Mount Sinai, told 

. “One of the ideas behind the trial is to determine whether the procedure is safe, and that is the case; the procedure is not associated with increased adverse events. There is a measurable benefit, but it's not yet ready to be [developed] in [the] clinic.”

Early-Life Bifidobacteria Linked to Lower Food Allergy Risk

 in February 2026 reported that early colonization with aromatic lactate–producing bifidobacteria was associated with lower risk of food allergen sensitization and atopic dermatitis.

“There's no causal link at this moment,” investigator Susanne Brix-Pedersen, professor at DTU Bioengineering told 

. “As I see it, we have this prospective study where we see associations, but we don't have any studies that have been designed to actually look at the causal interaction at this moment. We are undertaking a bigger study in 1000 Danish infants, where we are trying to…investigate this in detail.”

The cohort followed 147 children from birth to age 5, with serial fecal sampling at 8 time points alongside maternal samples, blood draws, and clinical assessments. Investigators identified a microbiota–metabolite–immune axis in which infants with higher abundance of specific bifidobacteria, particularly within the first 6 months of life, had elevated levels of aromatic lactates and reduced food allergen–specific immunoglobulin E (IgE) through age 5. The protective association appeared mediated by 4-hydroxy-phenyllactate (4-OH-PLA), a bacterial metabolite that selectively inhibited IgE production in ex vivo human immune cell cultures without affecting IgG.

Infants with higher levels of these bacteria also had reduced rates of atopic dermatitis at age 2. Early-life exposures influenced colonization, with vaginal delivery, exclusive breastfeeding during the first 2 months, and exposure to older siblings associated with greater acquisition. Vaginally delivered infants were up to 14 times more likely to acquire the strains from their mothers.

Dietary Epitopes Identified as Drivers of Oral Tolerance

New translational research has identified 

discrete dietary epitopes that drive oral tolerance

. The research, published in Science Immunology in March 2026, offers mechanistic insight into how the immune system classifies foods as safe.

Investigators isolated intestinal regulatory T (Treg) cells in murine models fed standard chow and mapped their T cell receptor (TCR) specificity, identifying 3 dominant epitopes derived from seed storage proteins in corn, wheat, and soybean. One of the strongest responses targeted α-zein, a digestion-resistant maize storage protein.

Investigators observed convergence on a limited number of antigens, suggesting a small set of dietary proteins may disproportionately shape immune tolerance. Antigen-specific Treg populations emerged around weaning, coinciding with introduction of solid foods and aligning with clinical evidence supporting early allergen exposure to promote tolerance.

The identified Treg cells demonstrated canonical immunosuppressive functions, including anti-inflammatory cytokine secretion and inhibition of effector T cell proliferation. The study also identified cross-reactivity, with TCRs recognizing a soybean-derived epitope responding to structurally similar proteins in sesame and quinoa.

“What this could suggest, and my lab is working on this a bit now, is perhaps if we could map cross-reactivity for things like a peanut, you could become tolerant to peanut by eating something that has those shared proteins without actually having the peanut exposure,” said Jamie Blum, PhD, from the Salk Institute, in an interview with 

What The Studies Mean for Food Allergy Prevention

Food allergy prevention before sensitization has not yet become a reality. These studies are still in the early stages, with more research needed to confirm whether these strategies will work.

For now, the guidelines recommend food introduction beginning at 4-6 months of age. The addendum guidelines suggest first consulting an allergy specialist who can perform peanut allergy testing, followed by trying peanut for the first time at a doctor’s office.

“I'm going to steal it from the Australians… eat early and eat often,” Chase said. “We don't want children to be exposed to foods that might be choking hazards, but really to otherwise go ahead and try and expose them to everything they're eating. I have a lot of families where they are nervous for whatever reason, because maybe another child has a food allergy…those parents need to be offered an evaluation by an allergist because they may not be willing to do it at home to introduce foods early. Putting the food directly into the baby's mouth and…exposing them to it on a semi-regular basis [is] what's been shown to reduce your food allergy risk.”

Watch the dynamic video on food allergy prevention, featuring Chase, Clemente, Brix-Pedersen, and Blum, 

Clemente J, Brix-Pedersen S, Blum J, et al. The Early-Life Window: Can Food Allergy Be Prevented Before It Begins? HCPLive. Published on April 13, 2026. Accessed on April 15, 2026. 

https://www.hcplive.com/view/early-life-window-can-food-allergy-prevented-before-begins-

Upton J. VLOIT Boosts Multi-Nut Tolerance in Children, With Julia E. M. Upton, MD, MPH. HCPLive. Published on January 17, 2026. Accessed on April 15, 2026. 

https://www.hcplive.com/view/vloit-boosts-multi-nut-tolerance-in-children-julia-upton-md-mph

Du Toit G, Sampson HA, Plaut M, Burks AW, Akdis CA, Lack G. Food allergy: Update on prevention and tolerance. J Allergy Clin Immunol. 2018 Jan;141(1):30-40. 

. Epub 2017 Nov 27. PMID: 29191680; PMCID: PMC12548800.

Derman C. Early Peanut Introduction Guidelines Linked to Drop in Food Allergy Rates. HCPLive. Published October 20, 2025. Accessed April 15, 2026. 

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

Clemente J. Vaginal Seeding Partially Modifies Infant Microbiome in ACTIVATE, With Jose Clemente, PhD. HCPLive. Published on March 1, 2026. Accessed on April 15, 2026. 

https://www.hcplive.com/view/vaginal-seeding-partially-modifies-infant-microbiome-activate-jose-clemente-phd

Brix-Pedersen S. Early-Life Bifidobacteria Linked to Lower Food Allergy Risk, With Susanne Brix Pedersen. HCPLive. Published on February 4, 2026. Accessed on April 15, 2026. 

https://join.hcplive.com/view/early-life-bifidobacteria-linked-lower-food-allergy-risk-susanne-brix-pedersen

Blum, J. Dietary Epitopes Drive Oral Tolerance, With Jamie Blum, PhD. HCPLive. Published on March 26, 2026. Accessed on April 15, 2026. 

https://www.hcplive.com/view/dietary-epitopes-drive-oral-tolerance-jamie-blum-phd

Articles

Early-life interventions are increasingly positioned to shift food allergy care from post-sensitization management toward primary prevention. Evidence supports early allergen introduction, including LEAP-derived reductions in peanut allergy and emerging real-world declines after guideline adoption. Very low-dose oral immunotherapy can substantially raise reaction thresholds in already-allergic young children, though it is not primary prevention. Parallel lines of investigation implicate microbiome modulation (eg, vaginal seeding, bifidobacterial metabolites) and defined dietary epitopes driving antigen-specific Treg responses as mechanistic levers for durable oral tolerance.

Evidence from 3 recent studies explores microbiome modulation, early allergen exposure, and immune tolerance as pathways for food allergy prevention.

Can Food Allergy Be Prevented Before It Begins? A Look At 3 Recent Studies

Although Wilson disease is considered rare, experts at a recent HCPLive clinical forum convened by Valentina Medici, MD, a professor in the division of Gastroenterology and Hepatology at University of California Davis, emphasized that its true prevalence may be underestimated due to frequent underdiagnosis and delayed recognition.

A rare inherited multisystem disorder affecting approximately 1 in 30,000 individuals worldwide, Wilson disease primarily impacts hepatic and neurological function and stems from pathogenic mutations in the ATP7B gene, which impairs the liver’s ability to excrete excess copper. Copper accumulation damages the liver and brain, and without daily treatment, the disease is fatal.

At the forum, clinicians discussed real-world challenges in identifying and managing the disease, highlighting diagnostic uncertainty, variability in presentation, and evolving treatment approaches.

Participants noted that most clinicians encounter only a small number of cases throughout their careers, limiting familiarity and contributing to missed or delayed diagnoses. While the disease is traditionally considered uncommon, emerging data suggest that genetic prevalence may exceed clinical detection, reinforcing concerns that many cases go unrecognized.

A Rare Disease With Broad, Atypical Presentations

A central theme of the discussion was the heterogeneity of Wilson disease. While hepatic manifestations are the most common, it can affect multiple organ systems, including the brain, kidneys, and musculoskeletal system.

Of note, only about half of patients present with “classic” features. The remaining patients fall into less typical presentations, which may include subtle liver abnormalities, neurologic symptoms, or 

Panelists emphasized that these atypical cases are a major driver of missed diagnoses. Patients are often initially labeled with more common conditions such as 

 or autoimmune hepatitis, particularly when liver enzyme abnormalities are mild or nonspecific.

Neurologic and psychiatric symptoms can further complicate recognition. Movement disorders, tremors, and speech abnormalities may emerge gradually, while psychiatric manifestations like anxiety or behavioral changes are often underrecognized and difficult to attribute to an underlying metabolic disorder.

Diagnostic “Gray Zones” and Testing Limitations

Despite established diagnostic criteria, experts highlighted persistent challenges with commonly used tests. Ceruloplasmin, a widely used screening tool, lacks sensitivity and specificity and may be normal or borderline in some patients.

Similarly, 24-hour urinary copper excretion and hepatic copper quantification can be influenced by factors such as inflammation, cholestasis, and treatment status, further complicating interpretation.

These limitations contribute to what panelists described as “diagnostic gray zones,” where clinical suspicion may be high but test results remain inconclusive. In these cases, clinicians often must integrate multiple data points, including clinical presentation, laboratory findings, and, when available, genetic testing.

The Leipzig scoring system was referenced as a helpful framework, though experts acknowledged that it does not fully resolve diagnostic ambiguity in complex cases.

Ultimately, panelists emphasized that clinical suspicion remains critical, particularly in younger patients with unexplained liver abnormalities or neurologic symptoms.

Delays in Diagnosis, Missed Opportunities

The forum highlighted significant delays in diagnosing Wilson disease, particularly in patients with neurologic or psychiatric presentations. In some cases, diagnosis may be delayed by several years, with psychiatric manifestations taking even longer to be correctly attributed to the disease.

These delays can have serious consequences, as untreated disease may progress to advanced liver disease, neurologic impairment, or acute liver failure. Clinicians shared examples of patients presenting late in the disease course, including those requiring urgent liver transplantation.

Panelists stressed that maintaining a high index of suspicion is essential, especially given the overlap between Wilson disease and more common conditions. Even borderline laboratory findings should prompt further evaluation when clinical concern remains high.

A Multidisciplinary Approach to Treatment

Management of Wilson disease extends beyond copper reduction alone. While chelation therapy and zinc remain the foundation of treatment, experts emphasized the need to address neurologic and psychiatric manifestations separately.

Neurologic symptoms may improve with treatment if identified early, but delayed diagnosis can limit reversibility. Psychiatric symptoms, in particular, are often persistent and require dedicated management, including pharmacologic and supportive care.

Long-term adherence to therapy remains a significant challenge, especially among patients diagnosed at a younger age. Panelists highlighted the importance of multidisciplinary care teams, including pharmacists, dietitians, and mental health professionals, to support adherence and optimize outcomes.

Family screening was also emphasized, given the genetic nature of the disease, with siblings and relatives often requiring evaluation.

Looking ahead, participants discussed the potential impact of emerging therapies, including gene therapy and novel agents targeting copper metabolism. Early data from clinical trials suggest that gene therapy may allow some patients to discontinue standard treatments, though these approaches remain investigational.

New diagnostic tools are also under investigation, including biomarkers and advanced histologic techniques that may improve diagnostic accuracy in challenging cases.

Despite these advances, experts emphasized that improving outcomes in Wilson disease will depend largely on earlier recognition and more consistent application of existing diagnostic strategies.

The discussion underscored a key challenge in Wilson disease care: while effective treatments exist, they are only impactful when the disease is identified early. Given the variability in presentation and limitations of current diagnostic tools, clinicians must remain vigilant, particularly when evaluating younger patients with unexplained hepatic, neurologic, or psychiatric symptoms.

As research continues to advance, the potential to improve outcomes is growing. However, for now, panelists agreed that heightened awareness and clinical suspicion remain the most powerful tools for closing the diagnostic gap in Wilson disease.

Wilson Disease Association. Wilson Disease. Published August 13, 2021. Accessed April 15, 2026. 

https://wilsondisease.org/do-i-have-wilson-disease/?gad_source=1&gad_campaignid=16684019432&gbraid=0AAAAADN9hfNH0Qklo1N7KKX3qO0womQLJ&gclid=CjwKCAiAw9vIBhBBEiwAraSATuJdNxoP57_7zjL0DUUF0B9EceR3whBrdSIFmutmQSsj2E3BL4nQkhoC-xwQAvD_BwE

NIDDK. Diagnosis of Wilson Disease. October 2018. Accessed April 15, 2026. 

https://www.niddk.nih.gov/health-information/liver-disease/wilson-disease/diagnosis

Wilson disease remains clinically “rare” yet likely underdetected, with genetic prevalence outpacing real-world diagnosis. ATP7B mutations impair biliary copper excretion, driving multisystem copper toxicity with fatal outcomes absent daily therapy. Marked phenotypic heterogeneity—often nonclassic hepatic, neurologic, or psychiatric presentations—fuels diagnostic delays and misattribution to common liver and neuropsychiatric disorders. Standard tests (ceruloplasmin, urinary and hepatic copper) create interpretive gray zones, making integrated assessment and sustained clinical suspicion essential. Multidisciplinary, adherence-focused care, family screening, and emerging gene/copper-targeted therapies may improve outcomes.

Clinicians discuss diagnostic gaps, treatment strategies, and multidisciplinary care in Wilson disease.

Diagnostic Challenges and Evolving Care in Wilson Disease

Cardiovascular and Cardiometabolic Risk in HS Demands Greater Clinical Attention, With Raj Chovatiya, MD, PhD

Patients with hidradenitis suppurativa (HS) face a broad spectrum of cardiovascular and cardiometabolic comorbidities, with risk elevations for multiple major outcomes that are consistent across study designs and geographic regions, according to a recent review and meta-analysis presented at the 

2026 American Academy of Dermatology (AAD) Annual Meeting

 held in Denver, Colorado, from March 27-31.

caught up with investigator Raj Chovatiya, MD, PhD, clinical associate professor of medicine at Rosalind Franklin University Chicago Medical School and founder and director of the Center for Medical Dermatology + Immunology Research in Chicago, Illinois, during the meeting, who argued that these findings should push dermatologists toward more systematic cardiovascular risk assessment in patients with HS.

The study was a PRISMA-guided systematic review and random-effects meta-analysis of studies identified through a search of PubMed, Embase, Scopus, CINAHL, and the Cochrane Library from inception through June 16, 2025. Twenty-five studies encompassing 373,689 patients with clinician-diagnosed HS were included. Random-effects meta-analyses were performed using the DerSimonian-Laird estimator, with between-study heterogeneity quantified using Cochran's Q, τ², and I².

Pooled prevalence estimates revealed a broad comorbidity profile across the included populations. Hypertension was the most prevalent condition, affecting 25.52% (95% CI, 20.88-30.45) of patients. Other pooled prevalence estimates included coronary artery disease at 4.2% (95% CI, 1.8-7.4), congestive heart failure at 1.9% (95% CI, 1.2-2.7), myocardial infarction at 1.9% (95% CI, 1.2-2.7), atrial fibrillation or flutter at 1.7% (95% CI, 1.0-2.6), cerebrovascular disease at 2.2% (95% CI, 1.2-3.3), and peripheral vascular disease at 2.2% (95% CI, 0.9-3.9).

The risk association analyses yielded findings Chovatiya described as the most clinically consequential output of the meta-analysis. HS was associated with a risk ratio (RR) of 1.85 (95% CI, 1.44-2.38) for heart failure, 1.75 (95% CI, 1.59-1.92) for coronary and ischemic heart disease, and 1.51 (95% CI, 1.22-1.88) for myocardial infarction. Risk of venous thromboembolism was also elevated, with an RR of 1.72 (95% CI, 1.45-2.05), as was all-cause mortality, with an RR of 1.86 (95% CI, 1.10-3.12). HS was additionally associated with a 52% increased odds of hypertension versus comparators (odds ratio, 1.52; 95% CI, 1.29-1.80). These associations were consistent across study designs and geographic regions. Chovatiya noted that while some pooled prevalence estimates were numerically similar to general population ranges, HS cohorts were disproportionately younger and female — populations in which this degree of cardiovascular risk is not typically expected — suggesting the clinical significance of these findings exceeds what raw prevalence numbers alone convey.

Chovatiya characterized the breadth of the comorbidity profile as the finding that most surprised him on reflection, noting that the aggregated published literature paints a picture of risk that extends across virtually every major cardiovascular outcome category. He framed the findings as supporting a shift toward routine cardiometabolic risk assessment and multidisciplinary preventive care in HS, while acknowledging that the most pressing unanswered question — whether timely targeted therapy modifies these outcomes — cannot be addressed by the existing retrospective observational evidence base. Most included studies lacked detailed reporting on HS severity, treatment exposure, and longitudinal risk factor trajectories, precluding causal inference. Prospective cohort studies and registry-based approaches capturing patients at or near disease onset will be needed to establish whether early intervention changes the cardiovascular trajectory in this population.

“I think what's really probably missing is, in addition to what I talked about [with] good prospective epidemiology, is trying to connect therapeutic intervention to some of these functional outcomes to see, indeed, if these are real risk factors, does timely intervention with targeted treatments make a difference,” Chovatiya said.

Chovatiya previously reported serving as an advisor, consultant, speaker, and/or investigator for AbbVie, Amgen, Apogee Therapeutics, Arcutis, Argenx, ASLAN Pharmaceuticals, Beiersdorf, Boehringer Ingelheim, Bristol Myers Squibb, Cara Therapeutics, Dermavant, Eli Lilly and Company, FIDE, Formation Bio, Galderma, Genentech, GSK, Incyte, LEO Pharma, L’Oréal, Nektar Therapeutics, Novartis, Opsidio, Pfizer Inc., Regeneron, RAPT, Sanofi, Sitryx, and UCB.

Mense SA, Hopkins T, Chovatiya R. Prevalence and risk of cardiovascular comorbidities and cardiometabolic factors in hidradenitis suppurativa: a systematic review and meta-analysis. Poster #76428. Presented at: AAD Annual Meeting; Denver, Colorado; March 27-31, 2026.

Egeberg A, Gislason GH, Hansen PR. Risk of major adverse cardiovascular events and all-cause mortality in patients with hidradenitis suppurativa. 

. 2016;152(4):429-434. doi:10.1001/jamadermatol.2015.6264

Videos

HS is associated with up to a nearly 2-fold increased risk of heart failure, coronary artery disease, myocardial infarction, venous thromboembolism, and all-cause mortality.

Once-Weekly Navepegritide Safe and Efficacious for Achondroplasia, With Carlos Bacino, MD

 approved Ascendis Pharma’s navepegritide treatment for 

 met with Carlos Bacino, MD, medical director of the Cytogenetics Laboratory at Baylor Genetics and a lead author on the pivotal ApproaCH study, which drove the FDA’s approval under the Accelerated Approval Program. Bacino discussed the reassuring safety data coming from the trial program.

“This is a drug that has been shown to be very safe in that the side effects have been mild and not clinically significant,” Bacino told 

. “These drugs do have an effect on blood pressure, potentially decreasing it – in this particular situation, this is something that has been looked at very carefully to determine if it has caused any clinical hypotension and decreasing blood pressure. In most cases, these side effects are minimal.”

Navepegritide is a prodrug of C-type natriuretic peptide (CNP) utilizing the TransCon technology platform, which is designed to transiently link an inert carrier to a parent drug with known biology. The moiety of CNP in navepegritide is identical to the amino acid sequence 89-126 of endogenous CNP – after weekly subcutaneous administration, autocleavage of the linker occurs under physiologic pH and temperature. This provides predictable, sustained release and continuous systemic exposure to active CNP.

The FDA’s decision was based on the pivotal ApproaCH phase 2b randomized, double-blind, placebo-controlled, multicenter trial, conducted across 10 academic hospitals across 7 countries. Patients aged 2-11 years with a genetically confirmed achondroplasia diagnosis who were naïve to treatment with growth-promoting agents and height recorded ≥6 months prior to randomization were eligible for inclusion. Patients with radiographic evidence of closed growth plates, severe untreated sleep apnea, or conditions known to affect growth, among other criteria, were excluded.

Patients were randomly assigned in a 2:1 ratio to receive either subcutaneous navepegritide at 100 µg/kg/week or placebo; both drugs were administered once weekly for 52 weeks, followed by 52 weeks of follow-up. A total of 86 patients were screened and 84 were enrolled, with 57 randomized to navepegritide and 27 to placebo. Navepegritide demonstrated superiority to placebo at week 52, as children receiving it achieved a least-squares mean AGV of 5.89 versus 4.42 cm/year for those treated with placebo.

Bacino also discussed the promising potential of weekly injections as opposed to daily treatment. He mentions the likelihood of increased adherence and more direct drug effects via the TransCon platform.

“The weekly injection will allow a much more physiologic delivery of the drug and will definitely improve adherence, as it is certainly better for children, who are often reluctant to needles,” Bacino said. “It’s also better for parents who are not necessarily happy about the frequency of injections, and it’s better for the busy family to be able to handle the drug regimen.”

Editors’ Note: Bacino reports disclosures with Ascendis Pharma, BioMarin Pharmaceutical, IONIS Pharmaceuticals, and Teladoc Health.

Ascendis Pharma. FDA Approves Once-Weekly YUVIWEL (navepegritide) for Children with Achrondroplasia Aged 2 Years and Older. February 27, 2026. Accessed April 15, 2026. 

https://investors.ascendispharma.com/news-releases/news-release-details/fda-approves-once-weekly-yuviwelr-navepegritide-children

Savarirayan R, McDonnell C, Bacino CA, et al. Once-weekly Navepegritide in children with achondroplasia. JAMA Pediatrics. 2026;180(1):18. 

Bacino highlights the recently approved treatment’s safety data and emphasizes the likelihood of increased adherence due to longer intervals between administration.

Patients are increasingly bringing AI-generated 

 advice into clinical encounters, raising new challenges for psychiatrists caring for individuals with severe mental illness. In this Q&A, Richard Miller, MD, staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, Rhode Island, discusses how tools such as ChatGPT are shaping conversations in outpatient psychiatry.

 present AI-derived recommendations, sometimes with limited context or accuracy. He explains how clinicians can validate patient curiosity while clarifying misinformation, protect the therapeutic alliance, and assess when AI use may reinforce maladaptive thinking. Miller also outlines potential roles for AI in documentation and education, emphasizing the need to maintain comprehensive, clinician-guided care.

Watch the dynamic feature on using AI as your therapist or psychiatrist, featuring Miller, 

 In your practice, are you already seeing patients use tools like ChatGPT for mental health advice, and what does that look like in real clinical encounters?

 I've seen it a lot, and it's not always good, and there needs to be some asterisks next to the information that they attain in the context.

Just for reference, I do outpatient psychiatry…serving the most sick folks in the community, [with] severe, persistent mental illness. A lot of patients [with] schizophrenia, bipolar disorder. I say that because those are the folks that are primarily coming to me with…statements [such as], “Hey, I plugged this into ChatGPT” or “I looked this up on AI, and this is what I've been told I need to talk to you about.”

These are individuals that at their baseline struggle with paranoia, sometimes with human validation…and they're putting stuff into an algorithm and getting an answer and maybe having a preconceived notion of what they want the answer to be. They're just coming to me with information which [are] not always accurate, largely inaccurate at times, and it's thrown together.

 How are patients interpreting the guidance that they get? Are they treating it as supplemental or as a substitute for clinical care?

 It's kind of both. There's some folks that I would say that are [a] bit higher functioning that might come to me and say, “Hey, I was looking this up because I know we've chatted about this, and this is what the ChatGPT has told me.” It might be based on a discussion we've had earlier…and it might supplement. Maybe it's something that is brand new and quite useful to both of us.

More often, it's actually deleterious where information is kind of cherry-picked, and the context is not always understood. Patients are kind of going on an extended trip and excursion to get the information that they're looking for…maybe [a] particular answer. I would say the higher the degree of functionality, in large part, I find it to be more deleterious than useful.

 When a patient brings in an AI-generated device, how do you approach that conversation without undermining the trust or therapeutic alliance?

 I always ask them where they're coming from and how they got the information. I always validate them and say, “Hey, thanks for bringing this to my attention. Thank you for sharing this with me. However, let's talk, or let's see what the entirety of the picture is.”

 Do you think clinicians should be proactively asking about AI use as a part of a routine history taking?

 Proactively, I'm not sure, but it should be part [of] the background to make sure they understand that a lot of people are looking into this. That's not something that has to be [at] the forefront of the discussion, but something that needs to be kept on the burner.

What concerns you most about patients with mental illness using AI as a therapist or psychiatrist?

 There's a reason I went to medical school…we need to put together the entire clinical picture.

My biggest concern is that patients are getting information piecemeal and [poorly] putting together to create a recipe or a puzzle… Pieces are not appropriate. They're not getting the entire clinical picture.

 Are there specific red flags that suggest AI use is becoming clinically problematic or reinforcing maladaptive thinking?

 It really depends. I don't want you to think I'm in a clinic where people are coming in every session with AI information. It comes up [about] 3 times a week.

It's caught me off guard sometimes; sometimes people you wouldn't expect [use AI]. It's becoming more prominent. It's kind of forcing us, in a good way, to stand our toes, to make sure that we are aware that these technologies are out there, and sometimes they are sources of misinformation.

 Where do you see the most practical appropriate role for AI in psychiatric care, whether in documentation screening or decision support?

 There is a lot of AI-generated software that's helping with documentation. I don't use it, not because I am against it, because we don't support it in my…place of employment.

It’s good to encourage patients to think more and learn more about their illness, but [it] really depends on the patient. Somebody who's paranoid…is going to maybe be more susceptible to misinformation… whereas somebody who did not suffer from psychosis might be able to see through it a little bit and [understand] some of [the information] may not be accurate.

In this interview, Miller discusses patients using ChatGPT for mental health advice, risks in severe mental illness, and how clinicians respond.

Patients Bring ChatGPT to Psychiatry Visits, With Richard Miller, MD

EPI Explained: Symptoms, Diagnosis Challenges, and Treatment Gaps

 is an underrecognized yet clinically significant condition that can profoundly affect digestive health and nutritional status. Characterized by inadequate pancreatic enzyme activity, EPI often presents with nonspecific gastrointestinal symptoms that overlap with more common disorders, making it easy to miss in routine practice.

EPI is increasingly recognized, but remains frequently underdiagnosed in clinical practice.

Symptoms are often nonspecific, including chronic diarrhea, bloating, and abdominal discomfort.

High-risk patients include those with chronic pancreatitis, pancreatic cancer, IPMNs, or prior pancreatic surgery.

Diagnosis is challenging due to limitations of current tests, including fecal fat collection and fecal elastase.

Pancreatic enzyme replacement therapy (PERT) is the cornerstone of treatment, but delays in diagnosis and limited therapeutic options remain key unmet needs.

In a recent discussion, Sarah Enslin, PA-C, and Jennifer Geremia, PA-C, highlighted the evolving understanding of EPI, emphasizing the growing awareness of the condition, the challenges that continue to delay diagnosis, and the critical need for more effective testing and treatment strategies to improve patient outcomes.

Both experts pointed to the need for greater clinical awareness and improved diagnostic strategies for EPI, a condition they say is often overlooked despite its significant impact on patients.

Reflecting on trends in clinical practice, Enslin noted that EPI is not a new diagnosis, but rather one that clinicians are recognizing more frequently as awareness improves. In her view, the condition has likely been underdiagnosed for years, only now gaining broader attention as providers become more attuned to its presentation and associated risk factors.

Geremia echoed this sentiment, stressing that EPI should remain firmly in the differential diagnosis for patients with compatible symptoms and comorbidities. Both underscored that missing the diagnosis can have meaningful consequences, including poor quality of life and nutritional deficiencies.

The speakers highlighted the nonspecific nature of EPI symptoms as one of the greatest barriers to diagnosis. As Enslin explained, patients commonly present with vague complaints such as chronic diarrhea, bloating, and abdominal discomfort, all of which are symptoms that can easily be attributed to more common gastrointestinal disorders. While clinicians often associate EPI with chronic pancreatitis or cystic fibrosis, both experts emphasized the importance of broadening that perspective, pointing to additional at-risk populations, including patients with pancreatic cancer, intraductal papillary mucinous neoplasms, or a history of pancreatic surgery.

Geremia expanded this discussion beyond classic pancreatic disease, noting that EPI may also be missed in patients with less obvious pancreatic abnormalities, such as cysts or atrophy. They further emphasized that certain non-pancreatic conditions, such as prior gastric bypass surgery, inflammatory bowel disease, and celiac disease, should also prompt consideration of EPI, as it may coexist and go unrecognized.

Diagnostic challenges also remain a key issue. Enslin described the gold standard 72-hour fecal fat test as impractical for most patients, while the more commonly used fecal elastase test, though convenient, has notable limitations in accuracy. Both experts suggested that newer approaches, including breath or serum-based testing, could help address these gaps if validated and adopted more widely.

When discussing management, both experts pointed to pancreatic enzyme replacement therapy (PERT) as the cornerstone of treatment. As Enslin explained, therapy is individualized based on symptom improvement, with goals centered on reducing stool frequency, improving consistency, and alleviating bloating to enhance overall quality of life. However, they also identified important unmet needs, including the lack of non-porcine enzyme formulations for patients with dietary restrictions.

Ultimately, both experts agreed that while progress has been made in recognizing EPI, delays in diagnosis remain common. They stressed that continued efforts to improve awareness, refine diagnostic tools, and expand treatment options will be essential to improving outcomes for patients.

Editors’ note: Enslin reports no relevant disclosures. Geremia reports relevant disclosures with Madrigal, Ipsen, Pfizer, AbbVie, and others.

Cleveland Clinic. Exocrine Pancreatic Insufficiency (EPI). June 10, 2021. Accessed April 15, 2026. 

https://my.clevelandclinic.org/health/diseases/21577-exocrine-pancreatic-insufficiency-epi

NIDDK. Definition & Facts for Exocrine Pancreatic Insufficiency. January 2023. Accessed April 15, 2026. 

https://www.niddk.nih.gov/health-information/digestive-diseases/exocrine-pancreatic-insufficiency/definition-facts

Drugs.com. Medications for Pancreatic Exocrine Dysfunction. April 15, 2026. 

https://www.drugs.com/condition/pancreatic-exocrine-dysfunction.html

Sarah Enslin, PA-C, and Jennifer Geremia, PA-C, discuss the diagnosis and management of EPI, reflecting on ongoing challenges in the field.

Missed and Misunderstood: The Ongoing Challenges of Exocrine Pancreatic Insufficiency

Is TSW Becoming More Accepted in Dermatology? With Brad P. Glick, DO, MPH

Topical steroid withdrawal (TSW) syndrome is considered by some to be a controversial topic in the 

 world today, but it is becoming more widely discussed among clinicians and patients.

Brad Glick, DO, MPH, a board-certified dermatologist and dermatologic surgeon known for his role at the Glick Skin Institute, spoke with the 

 in Denver, Colorado, about this topic and others covered in his session at the conference. He was first asked whether TSW is becoming more accepted as a real condition in the dermatology space.

“[Just] ask the country of Canada…and Great Britain, where there are now specific warnings and package inserts for topical corticosteroids, about TSW,” Glick expressed.

He addressed the growing recognition of TSW, describing the condition as increasingly supported by emerging research and international regulatory acknowledgment around the world. Glick added, despite some remaining skepticism within the dermatology community, that mounting data and patient presentations are contributing to TSW’s broader acceptance as a real condition.

From a clinical standpoint, he described several characteristic features to aid clinicians in their identification of TSW. Such characteristics include diffuse erythema, especially involving the face, as well as more distinctive findings such as the “sleeve sign.” This sign is marked by the sharp demarcation of erythema located on patients’ wrists or ankles, as well as erythema of the lower extremities.

Glick further referenced recent mechanistic insights suggesting a potential role for metabolic pathways, including NADH-related processes, in driving rebound inflammation following chronic or moderate topical corticosteroid use, potentially helping to clarify the pathophysiology underlying TSW.

Additionally, he pointed to the role of patient awareness and social media in amplifying recognition of TSW. Specifically, Glick described a marked increase in inquiries among patients following educational presentations on the subject. Despite acknowledgement of online discourse sometimes overstating various concerns, he emphasized that clinicians are encountering individuals with symptoms aligned with TSW in clinical practice.

 with a broader perspective on therapeutic innovations in dermatology in 2026. Glick pointed to the expansion of non-steroidal topical agents’ availabilities as a notable advancement, adding that such shifts may help patients’ disease control and may diminish their reliance on intermittent corticosteroid use. Later, Glick noted the sustained impact of biologic drugs in the current armamentarium, particularly in psoriasis and atopic dermatitis.

Looking ahead, Glick expressed optimism regarding the development of novel oral medications, and this was described by Glick as especially true for psoriasis. Such developments may complement existing biologic and topical options for patients with dermatologic diseases. Nevertheless, the critical barrier of access was cited by Glick as remaining, with prior authorization requirements being described as a persistent obstacle.

The quotes used in this interview summary were edited for clarity.

Glick has served as an adviser, consultant, speaker, or investigator for Amgen, AbbVie, AstraZeneca, Almirall, Arcutis, Bausch Health/Valeant, Ortho Dermatologics, Boehringer Ingelheim, Bristol-Myers Squibb, Brickell Biotech, Cara, ChemoCentryx, Dermavant, Dermira, Eli Lilly, EPI/Novan, Incyte, Janssen Pharmaceuticals, LEO Pharma, Galderma, Nimbus Lakshmi, Inc, Novartis, Sun Pharma, Pfizer, Sanofi, Regeneron, UCB and the CorEvitas AD, CorEvitas PSO, and PROSE Registries and is a shareholder of Top MD

Lio P. Addressing Doubts About Topical Steroid Withdrawal (TSW), with Peter Lio, MD. HCPLive. June 10, 2025. Accessed December 12, 2025. 

https://www.hcplive.com/view/addressing-doubts-about-topical-steroid-withdrawal-tsw-peter-lio-md

Glick B, et al. S065 What's New in Dermatology. Session presented at: 2026 American Academy of Dermatology Annual Meeting; March 27–31, 2026; Denver, CO.

In this interview from AAD 2026, Glick speaks about key insights on topical steroid withdrawal (TSW) and on the future of dermatology.

 has accepted a supplemental New Drug Application (sNDA) for delgocitinib (Anzupgo) cream for the treatment of moderate-to-severe 

LEO Pharma’s FDA-accepted sNDA seeks to extend topical delgocitinib (ANZUPGO) to adolescents (12–17) with moderate-to-severe chronic hand eczema inadequately controlled with, or inappropriate for, topical corticosteroids. The application is supported by the 16-week phase 3 DELTA TEEN RCT, which reportedly achieved IGA-CHE treatment success and key secondary endpoints, though full peer-reviewed data remain pending. If approved, this would address an adolescent-specific therapeutic gap. Interpretation should incorporate JAK-class warnings and limited long-term pediatric safety data.

The FDA has accepted LEO Pharma's sNDA for delgocitinib cream for moderate-to-severe chronic hand eczema in adolescents. 

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