Evaluation of eczema, asthma, allergic rhinitis and allergies among the grade-7 children of Iqaluit

Abstract

Background Little is known about the prevalence of asthma, allergic rhinitis, eczema and allergies among Canadian Inuit children, especially those living in the arctic and subarctic areas. Methods A cross-sectional study among grade seven students attending schools in Iqaluit, the capital city of Nunavut, was conducted during the 2016/2017 school year. We used the International Study of Allergy and Asthma in Children (ISAAC) questionnaire with added questions relevant to the population. In addition, skin prick tests (SPT) were conducted to test for sensitization to common food and environmental allergens. Results The prevalence of current asthma is 5.2%, all of them were males and 2/3 of them were Inuit and all had a previous respiratory hospitalization. Past asthma prevalence is 8.6%, 60% males and 60% Inuit. There was an inverse relationship to crowdedness possibly as a confounding factor because of getting a higher prevalence among the non-Inuit who usually live in less crowded houses. Current allergic rhinitis prevalence is 8.6%, 60% of the cases were among the mixed Inuit/Caucasian ethnicity while no cases among the non-Inuit, there was a female predominance 3:2. Past history of allergic rhinitis prevalence is 10.3%, half of the cases were among the mixed ethnicity (5.2% of that ethnicity) followed by Inuit (3.4%) and non-Inuit (1.7%), female: Male ratio 1:1. Current eczema prevalence was 27.6%, with half of the cases among the mixed ethnicity (13.8% of that group), followed by Inuit (8.6%). There was a female predominance with protective effect of exclusive breastfeeding. Past eczema prevalence 34.5%, with half of the cases were among the mixed ethnicity (17.2% of that group), followed by Inuit (10.3%). There was a female predominance. We noted a high rate of sensitization to Cat at 29.2%, most of the cases were among the mixed ethnicity, while absent sensitization to other common inhalant allergens. Conclusion While being cautious about firm conclusions due to the small sample size and power, the noticed variations in the prevalence and risk factors of asthma, allergic rhinitis and eczema among different ethnicities living at the same subarctic environment might be related to several possible explanations like genetic, gene-environment interaction and/or lifestyle factors, it was out of the scope of this study to determine the causality of such variation in prevalence, which emphasizes the need for further investigation.

Atopic dermatitis among children and adolescents in the Arctic region – a systematic review and meta‐analysis

“…Cumulative incidence of AD ranged betweencountries from 10% in Greenland 29 to 37% in Norway 17 and the 1-year prevalence of AD ranged from 10% in Greenland 29 to 28% in Canada. 13 The greatest with-in-country variation was observed in Norway and ranged from 19 to 37% for cumulative incidence and 13-26% for 1-year prevalence. 17,21 Overall, AD was more common in the Arctic regions of Scandinavia 17,25 and the lowest cumulative incidence and 1-year prevalence was observed in Greenland (cumulative incidence 12%; 1-year prevalence 10%).…”

“…13,14,22,26,27,31 Fifteen studies were cross-sectional, 5 were prospective cohorts, and one was a retrospective cohort. The diagnosis of AD was based on questionnaire responses in 16 studies [13][14][15][16]18,19,[21][22][23][24][25][26][27][28][29][30] and on a clinical examination or health medical records in 5 (Table 2). 17,20,[31][32][33] Seventeen studies examined children aged 5-14 years, 2 examined children aged ≤2 years, 31,33 one examined adolescents aged 18-19 years, 30 and one examined children at the age of 2 years with follow-up at age 4, 8, 15 and 21 years.…”

“…2). [13][14][15][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Overall, there was no difference in the incidence between studies defining AD according to a clinical examination (23%, 95% CI [19][20][21][22][23][24][25][26] or an affirmative questionnaire response (23%, 95% CI 15-32). Nor was there any difference between studies of high (22%, 95% CI [19][20][21][22][23][24][25][26] or low quality (26%, 95% CI 20-32).…”

“…29 The prevalence of AD depending on race or ethnicity was reported in 6 studies and based on the results from the metaanalysis, the pooled cumulative incidence of AD was lower in indigenous participants (19%, 95% CI 13-26) compared to the overall Arctic population (23%, 95% CI 20-26). 13,14,26,27,31 In Greenland, one study found that children of European ancestry had an increased risk of AD compared to Inuit (HR 1.8, 95% CI 0.7-4.5) 31 while in Norway, one study found that Sami children had an increased risk of AD compared to children of European ancestry (RR 1.39, 95% CI 1.2-1.6). 27 A second study from Greenland found no association 26 studies from Canada found that the overall prevalence of AD was lower among Inuit (18-22%) compared to children of European ancestry (29-67%).…”

Approach to the Assessment and Management of Pediatric Patients With Atopic Dermatitis: A Consensus Document. Section I: Overview of Pediatric Atopic Dermatitis

“…15,16 In Canada, the prevalence of AD in children from Indigenous communities is higher than the prevalence reported in major cities, ranging from 16.5% to 27.6% in Iqaluit and a Native Reserve in Labrador. [17][18][19] In addition to racial differences, sociodemographic and economic determinants of health may play a role in AD prevalence, [20][21][22] with most studies reporting a correlation between higher socioeconomic status and increased AD prevalence. 23…”