episodes with positive symptom correlation for cough (66.7%) and regur-gitation (66.7%). The infant, after 7 months of anti-inflammatory therapy(budesonide), underwent laparoscopic Nissen fundoplication at 8 monthsof age and became essentially symptom free without the need for bron-chodilators, asthma controller medications, or anti-reflux therapy.CONCLUSIONS: This case demonstrates the need to evaluate bothacidic and non-acidic reflux as potential contributors to the pathogenesisof supra-esophageal morbidity such as persistent respiratory distress, evenin very young infants.

607 Case Presentation: A Case of Idiopathic HypereosinophilicSyndrome Intolerant of or Refractory to Available MedicalTherapy

M. Segal1, T. Craig2; 1Department of Internal Medicine, Thomas Jeffer-son University Hospital, Philadelphia, PA, 2Department of Allergy andClinical Immunology, Penn State University, Hershey, PA.RATIONALE: Multiple therapies for hypereosinophilia are available,however, sometimes are ineffective or poorly tolerated. Herein we presenta patient with idiopathic hypereosinophilia syndrome who failed mostavailable therapies.METHODS: Following exclusion of other diagnoses associated withchronic hypereosinophilia, and establishing the diagnosis of idiopathichypereosinophilia, therapy aimed at reducing peripheral blood eosinophil-ia, and hence associated symptoms and signs, were instituted in a sequen-tial fashion.RESULTS: Therapeutic trials that included corticosteroids, hydroxyurea,interferon-alpha, imatinib, omalizumab, and intravenous immunoglobulinfailed to yield a demonstrable reduction in serum peripheral eosinophil

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605 Treatment of Perennial Allergic Rhinitis and Its Impact onQuality of Life in Asthmatic Patients

K. Shamir1, P. F. Birnbaum1, R. Thakor1, K. M. Wiers2, B. Mikolich1;1Internal Medicine, Drexel University College of Medicine, Philadelphia,PA, 2Pediatrics, Maimonides Medical Center, Brooklyn, NY.RATIONALE: The purpose of the study was to determine if perennialallergic rhinitis (PAR) is under-diagnosed in asthmatics and if the treat-ment of PAR in asthmatics affects their quality of life according to theMark’s Asthma Quality of Life Questionnaire1 (MAQLQ).METHODS: The study selected 49 asthmatics and excludes those diag-nosed with PAR or receiving treatment for PAR. The remaining patientswere called and screened for PAR. Diagnosis was made on the basis ofhistory. Patients with undiagnosed PAR completed the MAQLQ survey.Medical therapy consisting of a nasal steroid and an oral antihistaminewas administered. After one month of therapy, patients were resurveyedusing the MAQLQ.RESULTS: 24/49 (49%) of the patients were excluded from the studybecause they carried the diagnosis of PAR or were being treated for thedisease. 13/25 (52%) of the remaining patients had symptoms of PAR.One patient was lost to follow up. Of the 13 remaining asthmatics withundiagnosed PAR who were treated, the mean decrease in MAQLQ (CI)was 7 (2-12) (n=12). Paired student T-test: p=0.02.CONCLUSIONS: PAR is under-diagnosed per our survey of a sample ofasthmatic patients. Treatment of PAR appears to improve the quality oflife in asthmatic patients according to the MAQLQ.1. Adams RJ. et al. Validity of a modified version of the Marks AsthmaQuality of Life Questionnaire. Journal of Asthma. 37(2):131-43, 2000

Apr.

606 An Infant With Persistent Wheezing Due to Non-AcidicEsophageal Reflux

F. M. Schaffer1, R. Bhanu Pillai2, I. M. Virella-Lowe1, C. Michael Bow-man1, R. Tutuian3, D. O. Castell3; 1Pediatric Pulmonary, Allergy andImmunology, Medical University of South Carolina, Charleston, SC,2Division of Pediatric Gastroenterology, Medical University of SouthCarolina, Charleston, SC, 3Division of Gastroenterology and Hepatology,Medical University of South Carolina, Charleston, SC.RATIONALE: We report the case of an 18 month old girl who present-ed with emesis, gagging, chronic cough, and wheezing. Despite the use ofaggressive anti-reflux and asthma controller medications, her symptomspersisted. This case exemplifies the need to utilize a combined multi-channel intraluminal impedance and pH study (MII-pH) to evaluate bothacidic and non-acidic reflux as potential contributors to the supra-esophageal morbidity found in some cases of persistent respiratory dis-tress.METHODS & RESULTS: The patient underwent an upper GI serieswhich showed spontaneous gastroesophageal reflux. Ranitidine/metoclo-pramide orally and nebulized albuterol and budesonide respules werestarted. Symptoms continued and an ambulatory esophageal pH studyshowed continued acid reflux. Lansoprazole was added, but symptomspersisted. A repeat 24-hour pH study showed the acid reflux was well con-trolled. A scintiscan demonstrated delayed gastric emptying without evi-dence of aspiration. A trial of baclofen was unsuccessful. Albuterol nebu-lizations (during wheezing episodes) and nebulized budesonide respuleshad little effect on her respiratory status. A MII-pH demonstrated full con-trol of the acid reflux but also evidence of multiple non-acid reflux

count, or signs and symptoms, either due to drug intolerance by the patientor to failed efficacy. Inclusion criteria for entry into an anti-IL5 protocolcould not be met.CONCLUSIONS: Available pharmacotherapy aimed at reducing periph-eral eosinophilia can be ineffective or associated with side effects worsethan the manifestations of idiopathic hypereosinophilia.

608 Effects of Asthma Bronchiale and Its Therapy on Bone Massin Children

J. Novak; Paediatric dpt., Hospital, Litomysl, CZECH REPUBLIC.RATIONALE: The aim of this study was to asses the influence of asth-ma and it’s therapy on bones.METHODS: Over a period of 12 - 40 months 158 patients at the age of4 - 17 years were treated for asthma. There were three groups of the asth-matics: The group with inhaled glucocorticoid ( IGC) treatment ( 105patients), a nonglucocorticoid ( nonGC) group ( 52 patients) and controls( 409 health children). Quantitative sonometry ( QUS) of the calcaneuseswas examined with CUBA McCue analyser. The patients with the valueof the Z- score BUA (VOS) bellow -1.5 were examined by Dual EnergyX-ray Absorptiometry (DXA) of bones, too.RESULTS: We have recorded a significant differences p < 0.05 in themedians Z- score of BUA and VOS among the groups IGC (lowest),nonGC and controls (highest). 21 of 102 patients with IGC had one or twoparameters bellow - 2.0 (21%) whereas nobody of the non IGC group.Sixteen patients (15%) with IGC and one patient (2%) from nonGC grouphad DXA Z- score of four lumbar vertebrae bellow - 2.0.CONCLUSIONS: There is evidence of the negative influence of asthmain childhood on bones. The IGCs are suspected to aggravate this bone dis-order.