Meet Dr. John F. Zwetchkenbaum - a Medical Advisor at Nectar. Dr. Z is the chief allergist and founder of Allergy & Asthma Physicians of Rhode Island. The motto of his practice is, “Treat the cause, defeat the symptom.”
1. Tell us a little bit about yourself. Do you have any allergies?
I’ve been a practicing allergist for 30 years. I always knew I wanted to help people with asthma because I lived with severe asthma and it prevented me from doing things I really enjoyed.
While attending Boston University, I realized that allergists understood asthma much better than pulmonologists, so in order to best help people, I knew I needed to be an allergist. During my residency at George Washington University Hospital, I saw that allergic rhinitis and asthma studies were divided between ENT and pulmonary departments, while allergy was combined with rheumatology and immunology was a separate subject focused on research. So for my fellowship, I attended the National Jewish Center for Immunology and Respiratory Medicine which combined everything I wanted to be able to help asthmatics.
While living in Colorado for my fellowship, I realized I wasn't having asthma symptoms with exercise or colds like I did back east. Since I was learning to be an allergist at the time, I recognized it was the lack of dust mites not causing inflammation in my airways. So when I moved back east, I put myself on immunotherapy allergy shots, then sublingual, and have been able to maintain the same decreased symptoms that I experienced in Colorado and get my asthma in remission.
"I have personally experienced how allergy immunotherapy can improve symptoms and quality of life. There's nothing better than being able to share that knowledge to help someone and then see them improve and feel better."
2. What is your job? What’s the best part? The most challenging part?
I am the chief allergist and founder of Allergy & Asthma Physicians of Rhode Island. The motto of my practice is, “Treat the cause, defeat the symptom.” I have personally experienced how allergy immunotherapy can improve symptoms and quality of life. There's nothing better than being able to share that knowledge to help someone and then see them improve and feel better. I find huge satisfaction in being able to figure what is causing their problem instead of just treating it.
The challenging part is that allergies are more complicated today than they were 15 years ago. The classic allergic rhinitis patient of the past was straightforward. Testing revealed their allergies and treatment resulted in excellent responses. Today, the people coming to an allergist often feel they have allergies, but are not allergic upon testing. They have also already tried to treat their allergies with first-line medications over-the-counter and when those treatments fail, they come to the allergist to find out why, making each case more complex.
3. What do you do for Nectar?
I am a medical advisor helping Nectar understand allergies and sublingual immunotherapy as I have been doing this in my practice for over 17 years. I'm looking forward to contributing to the growth of this new type of company to reach more people, be a resource for patients, and help with research trials.
4. What’s the biggest misconception people have about allergen immunotherapy (both subcutaneous and sublingual immunotherapy)?
I think the biggest misconception about subcutaneous immunotherapy is that patients need to be on treatment forever. It’s also believed to be too time-consuming and inconvenient. Patients drop out because they don’t see immediate benefit. What they don't recognize is that it is year in and year out that they have the same symptoms and are repeating the same cycle. This is what sublingual immunotherapy can help solve.
5. How do you foresee the treatment of allergies changing in the future?
I foresee more out-of-pocket costs from healthcare and patients are going to have to play more of a role in their treatment choices, including out-of-pocket expenses. That is where the sublingual has a lot of benefits.
Also, allergies are changing. It's not as black and white anymore and I believe our environment is changing our reactivity making people more allergic. Some theories point to the microbiome affecting regulatory T cells. I’ve also seen, particularly during the pandemic, an interaction of the endocrine system with the immune system causing it to become more reactive. I'm seeing a lot of women having a lot of problems with allergies; hives, itching, gut issues, and it's starting to affect their thyroid. This whole immune responsiveness is interrelated and the allergies are part of the worsening of all their other symptoms. As a result, physicians will need to rely more heavily on functional medicine, which is going after the root cause.
6. What’s your favorite outdoor activity and have allergies ever gotten in the way?
I love outdoor sports; skiing, cross-country skating, hiking, kayaking, and paddle boarding. Many sports triggered my asthma and I couldn't skate much as a child due to my asthma. Getting the allergic trigger of my asthma under control has allowed me to do the sports that my asthma limited when I was younger.