Meet the Board: John J. Oppenheimer, MD

John J. Oppenheimer, MD, says that allergists should not be dogmatic about how they approach patient care but rather provide an individualized approach.

“If I were to summarize my 30 years in medicine, it would be defined by an evolution in our attempt to personalize care, whether we’re talking about asthma, rhinitis, urticaria or food allergy,” Oppenheimer, a clinical professor of medicine at UMDNJ Rutgers University School of Medicine, an allergist at Pulmonary and Allergy Associates NJ and a Healio Allergy/Asthma Peer Perspective Board Member, told Healio. “That’s the exciting part. We talk about this being an art, and we’re trying to bring more science to it so we can be more precise with our choice of colors on the palate, so to speak.”

Oppenheimer spoke with Healio about advances he has witnessed over the length of his career and what he anticipates the next big research breakthroughs in the field will be.

Healio: How did you come to pursue allergy as your specialty?

John J. Oppenheimer

Oppenheimer: Choosing the field of allergy happened with time when I was in training. I remember observing an allergist take care of a person with asthma. They took a holistic approach to look at the triggers of this person’s asthma to figure out what they could do to really help them. I thought that was really remarkable.

Some of the illnesses we treat are potentially life threatening but, as a whole, the majority of what we do is help healthy people get healthier, which is a lot of fun. We’re able to work with people of all ages, and through your labors of love you’re able to provide them real direction. These illnesses can have significant impediments in their quality of life and their life as a whole, and sometimes we can make their lives amazingly better. My main focus is to treat people with asthma, cough and food allergy.

Healio: What challenges do you face regularly in practice that keep you up at night?

Oppenheimer: One challenge is dealing with the impediments brought on by the new paradigm of health care, but what keeps me up at night is making sure I am staying abreast of all of the changes that are happening across the many aspects of allergy — food allergy, urticaria, asthma, rhinitis and cough. Each one of them has a remarkably robust expanse of literature that is booming.

I’m stunned at how fast medicine is moving. The knowledge base is growing so quickly, which is amazing to see. We’re applying new technologies and I look forward to using artificial intelligence in our approach to care. We’re also beginning to think about genetics beyond just patient phenotypes. We’re moving from just identifying triggers of an individual patient’s asthma to looking at their genetic makeup that may explain how they best respond to a therapy. To me, that’s really earth shattering.

Healio: What do you like to do outside of clinical practice?

Oppenheimer: I enjoy cycling, and my hobby is amateur ham radio, which is sort of unusual but very fun.

Healio: What research have you been working on?

Oppenheimer: I have been doing research on trying to better phenotype response to asthma therapy. I was an author on the CAPTAIN study, published last year, which was a pivotal trial for single-inhaler fluticasone furoate plus umeclidinium plus vilanterol (Trelegy Ellipta, GlaxoSmithKline) — this therapy is a combination of a long-acting muscarinic antagonist, a long-acting bronchodilator and an inhaled steroid. In the trial we designed analyses to try to better stratify the likelihood of response based upon physical characteristics of the patient, such as whether they have allergic asthma, if they have an elevated eosinophil count peripherally, etc, and we have a few papers coming out on those results.

Healio: What advances are you most looking forward to over the next 10 years?

Oppenheimer: I’m looking forward to our use of biologic agents to provide greater precision in our care. The biologics we have thus far have really forced us to reappraise everything we’re doing to optimize delivery. In my lifetime as an asthma specialist, we used to look at people and say, ‘If you have asthma, you’re going to be treated with X, Y and Z.’ Everyone was treated the exact same way. Now we’re acknowledging that some people with asthma are T2-high, so they have an allergic phenotype, and we would treat them more aggressively with inhaled steroids. Another group of patients is T2-low, and we’re going to treat them more aggressively with bronchodilators.

Likewise, in the case of food allergy, we have learned so much. Thirty years ago, if someone had an egg allergy and I told them that I was going to give them a baked good with egg, you would have thought that I was an evil doctor. We’re now beginning to even recommend introducing foods early because they may have downstream effects whereby they reduce the likelihood of being allergic, as learned in the LEAP study.

This is all very exciting, and I am very pleased to see all of this evolving.

References:

• Du Toit G, et al. N Engl J Med. 2015;doi:10.1056/NEJMoa1414850.
• Lee LA, et al. Lancet Respir Med. 2021;doi:10.1016/S2213-2600(20)30389-1.

For more information:

John J. Oppenheimer, MD, can be reached at nallopp@gmail.com.