CONCLUSIONS: Researchers in this study found no associa- allergy issues and created a pathway with practical guidance tion between allergic sensitization and age at first vac- on allergy referral to further reduce allergist burden. cination, total number of vaccines, or receiving the REVIEWER COMMENTS: In the United States, there are ∼5000 measles-mumps-rubella vaccine. practicing allergists to care for 50 million people suffering REVIEWER COMMENTS: With increasing rates of unvaccinated from allergic conditions; the relative lack of allergist access children, it is important for medical providers to discuss results in long wait times for appointments and delay in concerns and skepticism with parents. This study is care. Primary care providers receive minimal allergy and consistent with previous studies showing no association immunology education during training. Researchers in this between routine childhood vaccination and allergic study describe a novel method of allergy care delivery that sensitization. Parents should be reassured that childhood trains health care professionals to provide allergy care, re- vaccines are not contributing to allergic sensitization. ducing wait times and allergy-related hospital visits. Con- cerns include a delay in care associated with inappropriate URL: www.pediatrics.org/cgi/doi/10.1542/peds.2019–2461M triage to the incorrect clinic; additionally, despite an initial Kelly Boyd, MD decrease in wait times, wait times later increased, suggesting J. Andrew Bird, MD the model may lead to overall increased health care usage. Dallas, Texas URL: www.pediatrics.org/cgi/doi/10.1542/peds.2019–2461N Neelam A. Phadke, MD The Impact of a General Practitioner–Led Michael Pistiner, MD, MMSc Massachusetts Community Paediatric Allergy Clinic: Boston, A Service Evaluation El-Shanawany IR, Wade C, Holloway JA. Clin Exp ENVIRONMENTAL EXPOSURES AND TOBACCO SMOKE Allergy. 2019;49(5):690–700 PURPOSE OF THE STUDY: Researchers in this study examined Air Pollution Exposure and Lung Function Until whether general practitioners with special training in Age 16 Years: The PIAMA Birth Cohort Study pediatric allergy could address unmet allergy needs. Milanzi EB, Koppelman GH, Smit HA, et al. Eur Respir J. 2018;52(3):1800218 STUDY POPULATION: Researchers in the study evaluated new referrals to doctor-led clinics for patients from Islington, a PURPOSE OF THE STUDY: Evidence for the effects of air pollu- borough of London; patients previously seen by the local tion exposure on lung function growth into adolescence allergy service or who were managed at a nurse-led clinic is scarce. Therefore, the purpose of this study was to were excluded. investigate the associations of air pollution exposure from birth with lung function growth from ages 8 to 16 and METHODS: Authors retrospectively reviewed referrals to Whit- lung function at age 16. Potential confounders (sex and tington Hospital Pediatric Allergy service to determine new- asthma diagnosis) were also explored. patient wait times, allergy-related hospital visits, and reasons for visit. A special interest general practitioner–led community STUDY POPULATION: The study was performed within the Dutch clinic (GPwSI) was created; wait times, allergy-related hospital population-based Prevention and Incidence of Asthma and visits, and patient satisfaction data were collected and com- Mite Allergy birth cohort. From the 3963 pregnant women pared for patients seen at the original hospital-based clinic and initially enrolled, 915 children (mean age: 16.3 years) had the new community clinic. sufficient longitudinal data for this study. RESULTS: Allergy-related hospital visits decreased for all METHODS: Both longitudinal (n 5 915) and cross-sectional patients but not always significantly. New GPwSI patients (n 5 721) analyses were conducted. Researchers esti- requiring follow-up was 1 in 132 patients in 2014 and 1 in mated residential concentrations of nitrogen dioxide, 40 patients in 2016. Hospital clinic wait times remained “soot,” and particulate matter (PMx, where x is the 50% unchanged from 2013 to 2014 (9.56 weeks versus 8.71 cutoff aerodynamic diameter in mm) with diameters of weeks); wait times for the GPwSI decreased to 6.66 weeks ,2.5 mm (PM2.5), ,10 mm (PM10), and 2.5 to 10 mm (2014) but later increased to 11.45 weeks (2016). Patients (PMcoarse) during the preschool, primary school, and and parents reported high satisfaction with the GPwSI. secondary school time windows by land use regression models. Associations with (growth in) forced expiratory CONCLUSIONS: The GPwSI linked primary and secondary volume in 1 second (FEV1) and forced vital capacity (subspecialty) care to decrease hospital visits for allergy- were analyzed by linear (mixed effects) regression. related problems and appropriately triage patients requiring allergy care in a method that provided high levels of patient RESULTS: Greater air pollution exposure was associated satisfaction and an initial decrease in wait times for allergy with reduced FEV1 growth (eg, adjusted difference: guidance. Authors also educated general practitioners on 20.26% [95% confidence interval: 20.49 to 20.03%] per

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