Ka Wai Ola - Office of Hawaiian Affairs, Volume 6, Number 2, 1 February 1989 — He Mau Nīnau Ola [ARTICLE+ILLUSTRATION]

He Mau Nīnau Ola

Some Health Questions by Kekuni Blaisdell, M.D.

Poi For Allergy in Aneieni Hawai'i: Mokuna 'Ekahi

Nīnau: E ke kauka, please explain how did the ancient Hawaiians cure allergy with poi? Pane: "Ancient Hawaiians" usually refers to our kūpuna kahiko prior to January 1778 when Capt. James Cook and eompany, the first foreigners, arrived here by accident. The term "allergy" how-

ever, was not coined in the West until 1906, by Clemens von Pirquet of Kelemania (Germany), 128 years later. Pre-haole kānaka maoli may have had an equivalent term or similar concept, but we do not yet have evidence for_this. No laila, to pane your ninau we need to maopopo (understand): (1) what "allergy" means; (2) in what forms it may have occurred in pre-Western Hawai'i; and (3) what information there may be on the use of poi for allergy in those early times and since.

Von Pirquet used "allergy" to mean "altered reaction" or hypersensitivity in a person upon exposure to a foreign substance, such as a germ or ehemieal called an antigen. An antigen is so-called because it stimulates the person's kino (body) to make specific chemicals called antibodies to the specific antigen. Upon re-exposure to the antigen,

the person's antibodies react with the antigen, usually to prevent mea 'ino (harm), such as infection, like measles. This is the classic basis for immunitv.

In allergy, the antigen is called an allergen. Upon initial exposure, antibodies are formed against the specific allergen like pollen. Upon re-exposure to the allergen, akā, the allergen-antibody reaction is 'ino (harmful) to the person. The resuiting disease is therefore called a form of allergy, like hanō

(asthma). I kēia wā, the varieties of mechanisms of allergic diseases are kūkapaila (numerous). No laila, they are usually māhele 'ia (divided) into four main types. Akā, only the eommon Type I anaphylactic form is shown here in Table 1 and in Figure 1. Common allergens, kino tissues affected, mau ma'i (illnesses) and usual forms fo treatment are listed. Did any of these ma'i occur in Hawai'i kahiko? Certainly not those related to strawberries, waiū pipi (cow's milk), cereals, peanuts, kokoleka

(chocolat'e), poison ivy, bees, mites and modern drugs — all of whieh were introduced after first haole contact. Akā, one may reason that since ma'i kihe (hay fever, allergic rhinitis), hanō laina (hives, urticaria). and pu'upu'u mane'o (dermatitis) are known to oecur in Hawai'i piha (pure Hawaiians) today, and since heredity plays a role in allergy, it is possible that these disorders did occur in Hawai'i kahiko, although not in response to those cillergens that had not yet been introduced to our native islands. What allergens could have been active i ka wā kahiko?

One probability is 'awa. Capt. Cook's journals of 1779 describe a scaling dermatitis in 'awa-drinking ali'i that cleared when 'awa use stopped. Modern studies have shown that such a reaction to 'awa consumption occurs in only a small percentage of persons, disappears when 'awa is discontinued and recurs with re-exposure. If one presumes that these pre-haole kānaka maoli also ate poi, then poi apparently did not prevent this presumed allergic dermatitis, although poi may have iessened the severity of the pu'upu'u mane'o. Another factor has also been hinted at above. Allergies, such as ma'i kihe, hanō and pu'upu'u mane'o, occur in only some persons and families, not all. Arthur Coca in 1923 called this "atopy," meaning out of the way. And since the 1966 discovery by the Ishizakas, we have learned that atopic allergy is mediated by a distinctive class of blood antibodies called "IgE," for immunoglobulin E.

Fig. 1 shows how an allergen, like 'awa or a particular fish substance, could stimulate the body to make a specific IgE antibody whieh would become attached to mast cells (tissue cells that contain histamine), in certain kino tissues. Ma hope (subsequently), re-exposure to such an allergen would then lead to union of the allergen to IgE. This would trigger ku'u (release) from the mast cells of strong kino chemicals, like histamine, whieh, in the 'ili (skin) would cause mane'o (itching), in the ihu (nose) would cause kihe (sneezing), and in the akemāmā (lung) bronchioles would cause hanō. How poi might affect such mechanisms and thus be useful for allergy will be considered i kēia mahina a'e. 'Oiai, e ho'omau e ha'awi mai nei i he mau ninau ola, ke 'olu'olu.

Table 1. Allergens, Tissue Sites, Disorders and Treatment in Type I Anaphylactic Allergy.

Figure 1. Initial exposure of allergen to the body stimulates production of lgE antibody whieh attaches to the mast eell. Subsequent exposure leads to allergen union with lgE on the mast eell. This causes re!ease of histamine from the mast eell. In the nose, hay fever results; in the skin, dermatitis results; in the lungs, asthma results.

Allergens Tissue Sites Disorders Treatment Foods: Pollens Na'au (gut) Gut allergy Avoid allergen Cow's milk Molds 'Hi (skin) Hives Anti-histamine Chocolate Dander Dermatitis Anti-release drug Egg Dusts Ihu (nose) Hay fever Hyposensitization Cereal Bee sting Akemama (lung) Asthma Immune suppressant Citrus Plants: Nuts Poison ivy Berries 'Awa Fish Infection Pork Drugs