Kirksville Allergy and Asthma is dedicated to improving the quality of life for people with allergies, asthma and immune diseases by providing the latest allergy and asthma care through expert treatment, education and compassion.
If you suffer from allergies, sinus disorders, asthma, skin allergies or other respiratory disease, you are not alone. Over 30% of us will suffer from one or more of these diseases. Fortunately, you don’t have to suffer with these allergic diseases-there is help available!
As a board-certified allergist/immunologist Dr Ciesemier has spent many years of specialty training to provide exceptional care for the entire family. Dr Ciesemier is dedicated to finding the cause of your problems, rather than just treating the symptoms. He uses state-of-the-art testing to help determine the cause of your condition. He will work with you or your child’s primary care physician as a team to utilize different treatments to help alleviate your suffering.
We offer care for all aspects of allergic diseases from food and drug allergies to environmental allergies, as well as, asthma and lung disorders
Dr Ciesemier is the only allergist providing allergy and asthma care and treatment in the northeast Missouri area. His primary office is located in Kirksville, Missouri with 3 other offices at: Davis County Hospital in Bloomfield, Iowa, Wright Memorial Hospital in Trenton, Missouri and Putnam County Hospital in Unionville, Missouri.
We are dedicated to provide our patients with the latest diagnostic modalities and therapies. We work closely with you and your-or your child’s primary care physician to provide expert treatment and education in the diagnosis and treatment of allergies and asthma.
We pledge to do our best for you and your child’s allergy and asthma care.
Allergist / Immunologists
An allergist / immunologist (commonly referred to as an allergist) is a physician specially trained to diagnose, treat and manage allergies, asthma and immunologic disorders including primary immunodeficiency disorders. These conditions range from the very common to the very rare and span all ages. In the United States, becoming an allergist / immunologist requires at least an additional nine years of training beyond a bachelor’s degree.
After completing medical school and graduating with a medical degree, physicians undergo three years of training in internal medicine or pediatrics and must be board-certified in that field.
Internists and pediatricians interested in becoming an allergist / immunologist have at least an additional two years of training, called a fellowship, in an allergy / immunology training program. These physicians then must pass a certifying allergy board exam.
Many of these individuals have achieved the rank of Fellow within the AAAAI. When you see “FAAAAI” alongside the designation of “MD” or “DO” you know that your allergist / immunologist has met the highest standards in the field.
Allergy testing involves application of a small amount of allergen just under the skin. Testing done by an allergist is safe and effective for adults and children of any age. The allergen extracts or vaccines we use in allergy tests (and treatment with immunotherapy) meet U.S. Food and Drug Administration (FDA) requirements. Some of the allergy symptoms for which we would consider allergy testing include:
- Respiratory: sneezing, itchy eyes, nose or throat; nasal congestion, runny nose, watery eyes, chest congestion, cough or wheezing
- Skin: itchiness or eczema
- Abdominal: vomiting or cramping and diarrhea after eating certain foods
- Severe reactions to insect stings
- Anaphylaxis (a serious, potentially life-threatening allergic reaction that can affect different systems of the body at the same time, to name a few. It is very important that allergy testing is directed by a fellowship-trained, board-certified allergist with sufficient allergy/immunology training based on your medical history.
Types of Allergy Tests: Different allergens affect people differently; we will determine which test is the best for you. Regardless of the type of test, Dr Ciesemier will first perform a physical examination and ask questions about your symptoms to determine if allergy testing is needed.
IgE Skin Tests: This type of testing is the most common and is relatively painless. The testing takes about 20-40 minutes and is performed by a nurse and interpreted by the doctor. A very small amount of certain allergens are put into your skin by making a small indentation or “prick” on the surface of your skin. If you have allergies, just a little swelling that looks and feels like a mosquito bite will occur where the allergen(s) to which you are allergic was introduced. You don’t have to wait long to find out what is triggering your allergies. Reactions occur within about 20 minutes. And you generally won’t have any other symptoms besides the small hives where the tests were done, which go away within 30 minutes. If your prick skin tests are negative but your physician still suspects you might have allergies, more sensitive “intradermal” tests may be used in which a small amount of allergen is injected within the skin. Skin tests are best performed in an allergist’s office to assure the test results are read properly and to minimize the risk of rare side effects.
Challenge Tests: A very small amount of an allergen is inhaled or taken by mouth. Challenges are done mostly with potential food or medication allergies. These are directly supervised by Dr Ciesemier, as allergic reactions can occur with type of testing.
Blood Tests: This test involves drawing blood, so results are not available as rapidly as with skin tests. IgE blood tests are generally used when skin tests might be unsafe or won’t work, such as if you are taking certain medications, or have a skin condition that may interfere with skin testing. These are done rarely-usually patients can stay off antihistamines 5 days before the testing.
Patch Tests: This test doesn’t prick the skin. Instead, an allergen is applied to a patch, which is then placed on your skin. This type of test can detect delayed allergic reactions. It’s generally done to see whether a particular substance is causing allergic skin irritation (contact dermatitis). During a patch test, your skin may be exposed to 20 to 30 extracts of substances that can cause contact dermatitis. These can include latex, medications, fragrances, preservatives, hair dyes, metals and resins. You wear the patches on your arm or back for 48 hours. During this time, you should avoid bathing and activities that cause heavy sweating. The patches are removed when you return to your doctor’s office. Irritated skin at the patch site may indicate an allergy.
Lung Function Testing
Spirometry: is a common office test used to diagnose asthma, chronic obstructive pulmonary disease (COPD) and certain other conditions that affect breathing. Spirometry may also be used periodically to check how well your lungs are working once you’re being treated for a chronic lung condition. Spirometry measures how much air you can inhale and exhale. Spirometry also measures how fast you can exhale. Spirometry values below average indicate your lungs aren’t working as well as they should.
Exhaled Nitric Oxide Testing: This is a test that is similar to spirometry in that you will blow into a device. This test checks for inflammation specifically from a certain type of cell that causes allergies and asthma. Patients with allergic airway inflammation generally have higher than normal levels of nitric oxide (NO) in their exhaled breath. By measuring the concentration of NO in an exhaled breath (fractional exhaled nitric oxide or FeNO), we can evaluate allergic airway inflammation if you have underlying asthma. The reasons Dr Ciesemier would obtain a nitric oxide measurement would be to assist with the diagnosis of asthma. It also helps to aid in the treatment of asthma by helping Dr Ciesemier guide stepwise changes in antiiflammatory medication (stepping up or down or discontinuing) and to help determine if you are using the inhaler properly.
Rhinoscopy: For certain types of sinus disease Dr Ciesemier may consider looking further into the nasal cavity. This is called rhinoscopy. This visual inspection will help rule out physical conditions that may trigger sinusitis such as nasal polyps or other abnormalities. A thin flexible tube (endoscope) with a fiber-optic light is inserted through the nose to allow inspection of the inside of your sinuses. This test is relatively painless and usually takes less than 5 minutes to perform.