ISEE-134 Introduction: We have previously examined the relationship between traffic-related air pollution and the development of asthmatic/allergic symptoms and respiratory infections in the first two years of life for a birth cohort (N∼ 4,000) study in The Netherlands. Here we present findings from analysis at age four. Methods: A validated model based on measurements and geographic modeling was used to assign outdoor concentrations of traffic-related air pollutants (NO2, PM2.5 and “soot”) at the home addresses of the cohort. Questionnaire-derived data on wheeze, dry nighttime cough, ear/nose/throat infections, skin rash and physician diagnoses of asthma, bronchitis, influenza and eczema at age four were analyzed in relation to air pollutants. Multiple logistic regression models controlled for gender, maternal age, parental education, parental allergy, maternal smoking, ETS exposure, other siblings, ethnicity, breastfeeding, mattress cover, and the presence of mold, pets and unvented gas appliances at home. Total IgE and specific IgE to Der p1 (house dust mite), Der f1 (house dust mite), Fel d1 (cat), Can f1 (dog), grass pollen, birch pollen, egg, milk and Alternaria was measured in a subset (n∼ 700) of the cohort. Results: Adjusted odds ratios for wheeze (e.g., OR=1.8, 95% CI = 1.1–2.7 for “soot”), doctor-diagnosed asthma (2.2, 1.1–4.7), ear/nose/throat infections (1.7, 1.1–2.5) and flu/serious colds (1.8, 1.1–3.0) indicated positive associations with air pollutants. No consistent positive associations were observed for eczema, skin rash, cough or bronchitis. In the subset of the cohort with objective measurements of allergic sensitization (specific IgE), we also observed positive associations between air pollution and sensitization to food allergens (e.g., 5.6, 1.0–15.8 for “soot”), but no indications of associations with sensitization to indoor or outdoor aeroallergens or with elevated total IgE. As sensitization to food allergens (28%) was more prevalent than sensitization to indoor (17%) or outdoor (9%) allergens, further follow-up is necessary to determine if this sensitization shifts towards aeroallergens at later ages. Conclusion: These findings at age four confirm earlier observations made at age 2 in the same cohort and indicate associations between exposure to traffic-related air pollution and asthma, allergy and respiratory infections in a birth cohort.