Eczema is a chronic relapsing disease that is characterized by erythematous pruritic skin lesions. Many factors affect its prevalence and severity. Susceptibility genes express a defective barrier protein (filaggrin), which increases epidermal permeability and water loss [1, 2]. The immune response to this permeability is affected by infectious and environmental factors [2, 3]. Its economic burden is considerable, and caregiver stress can exceed that of caring for a child with diabetes . Population surveys using the ISAAC protocol  show rates that vary widely- as low as 2% in China and eastern European countries, 8.5% in Canada, and 15.9% in Japan. The picture is fluid; some high prevalence countries have shown a decrease, while many developing countries with a low prevalence have experienced increases [6, 7]. Prevalence in the former East Germany rose to equal that of West Germany after reunification - too quickly to be explained by gene frequency changes, but coinciding with a more “Western” diet and other social changes.
Much time has been spent examining potential influences- the literature is complex and at times contradictory. Dietary and environmental changes parallel the rising rate of eczema although causality remains unproven . Gender, nutrition, number of siblings, allergic status, exposure to acetaminophen or antibiotics, vitamin D and climate have been examined [10–13]. Indoor exposure to dust, animal dander, molds, tobacco smoke, heating systems and aeroallergens may also play a role [14, 15]. Evidence is contradictory about the role of breastfeeding [16, 17]. Western and urban populations tend to have more eczema than those that are oriental and rural . Less exposure to childhood infections may cause higher rates of atopic disease (the Hygiene Hypothesis) .
The connection between atopy and eczema has been debated- the link is stronger in severe (hospitalized) patients and weaker in the community setting , stronger in affluent countries and weaker in developing ones . One early study noted elevated IgE levels in 43% of patients with eczema , and another in 2004 noted higher IgE levels in severe cases . Eczematous children commonly have food sensitization- 40% with moderate/severe eczema have food allergies . Milk and eggs can provoke flares in infants and some adolescents . The 2007 GA2LEN/EAACI recommendation  to consider food triggers is noteworthy, and there are plausible mechanisms to implicate IgE in chronic inflammation - in addition to its well-known role in acute hypersensitivity.
Little Canadian research has been done, although a 1999 questionnaire compared prevalence rates in the Canadian cities of Saskatoon, Saskatchewan (17.3%) and Hamilton, Ontario (15.4%) . It is worth noting that the children in this study were not examined, and that reported rates in surveys can be much higher (even double) rates observed in studies that include a clinical assessment .
There is limited information on eczema in circumpolar and First Nations communities. Sami children had a higher rate than their Norwegian schoolmates , and affluent Norwegian children had more than Russians . Inuit schoolchildren in northern Quebec had low rates of exercise induced asthma and atopy, although eczema rates were not assessed in this study .
This project was designed to assess the prevalence of childhood eczema in Natuashish, and the level of sensitization to foods now common in the diet of the Innu.