Ka Wai Ola - Office of Hawaiian Affairs, Volume 6, Number 3, 1 March 1989 — He Mau Ninau Ola [ARTICLE+ILLUSTRATION]

He Mau Ninau Ola

Some Health Questions by Kekuni Blaisdell, M.D.

Poi For Allergy: Mokuna 'Elua (Part II)

Ninau: E ke kauka, I have heard that some haole kauka in modern Honolulu prescribe poi for allergy. If so, does it work and if so, how does it work? Pane: There is evidence that even missionary kauka in the 19th century recog- , nized the nutritive value of poi and its efficacy in

eommon illnesses, such as 'ōpihapiha (eolie) in infants. By the 1940s in Hawai'i, there was also anecdotal evidence (not well documented stories) that poi could be dramatically effective in relieving what some kauka haole called "gut allergy." Akā; it was not until 1%2 that controlled scientific evidence was sought. In that makahiki (year), University of Rochester professor of pediatrics Jerome Glaser was a visiting professor in Hawai'i. He later reported the case of a 9-week kama iki (baby boy) with palahi (diarrhea), nāwaliwali (failure to thrive), and lua'i'ana (vomiting) after feeding of waiu pipi (cow's milk), waiū kao (goat's milk), and even soy bean milk, waiu hipa (lamb's milk) and other mea 'ai (food). Accordingly, the pēpē (baby) was considered to have severe "food allergy" affecting his na'au (gut). A trial of poi feeding however, was associated with impressive recovery. Thus, poi appeared to be Kauka Glaser's longsought ideal high-carbohydrate food substitute for allergenic cereals, such as wheat, rice, rye, barley, oat and eom, whieh, with waiū pipi, hua moa (egg), chocolate, citrus, nuts and i'a (fish), are the most eommon food allergens in infancy and childhood. Characteristic manifestations of allergy to_these food items are_'ōpihapiha, lua'i'ana, palahi, and sometimes hano (asthma), ma'i kihe (allergic rhinitis, "hay fever"), and mane'o (dermatitis). The theory is that protein allergens in these mea 'ai (foods) in genetically susceptible (i.e., "atopic") infants, are absorbed through the na'au into the koko (blood) circulation. In the kino (body) tissues, these food allergens stimulate the infant's immune cells, called lymphocytes, to make specific chemicals called antibodies, as described i kēlā mahina aku nei (last month). Upon re-exposure to the same food allergen, the allergen-antibody union results in troublesome symptoms described above. Avoiding the offending food allergens often relieves the symptoms, although some kauka believe that in some patients, onee the process is started, even eliminating the allergen from the diet

may not be effective and the patient may go on to manifest other allergic symptoms. Thus, it seemed even more desirable to avoid initial exposure ("sensitization") in potentially allergic, i.e., atopic, persons, with a family history of allergy (see Mokuna 'Ekahi, i kela mahina aku nei). In this way, food allergy might be prevented. Accordingly, in 1964, Kauka Glaser's experiences prompted Honolulu Kauka AIexander Roth, Robert Work and Ira Lichton to conduct a larger, oft-cited investigation. Recruited were 191 infants considered potenticdly allergic because at least one parent or sibling had major allergy, such as hano, mai' kihe and or dermatitis. The mothers of about half of the number of infants were to give only breast waiu and th_e other infants were to receive only soybean waiu. Hapa lua (half) of eaeh of these hui (groups) were to receive only poi as solid food, and the other hui only rice cereal beginning at age 6 weeks. No other foods were aIlowed during the 4-month period. At eaeh baby's monthly visit, a record was made of the presence or absence of the following evidences of "allergy:" eolie, gas, vomiting, diarrhea, constipation, excessive crying, nasal stuffiness, "mucous in chest," wheezing, eczema (dermatitis). Pertinent data from these records were later judged by two independent pediatricians as filling only one of three possible categories: "allergy," "no allergy," or "not sure." Nā hua (the results) are shown in Table 1. Only 128 (67%) of the starting infants completed the 4-month study. Po'e heluhelu (readers) should understand that all four treatment hui (breast waiu, soy waiu, poi and rice) are considered to be low or non-aller_genic. That is, there was no eomparison hui of pepe receiving usual allergenic feedings, such as waiū pipi. Thus, only about 7% of the high-risk infants showed "allergy" during the 4month period. Breast-fed pēpē fared better than soy waiu infants. Poi was similar to rice in the low occurrence of "allergic" symptoms, but no better. Pēlā, poi may also be effective in preventing food allergy, but if so, it does not appear to be superior to rice. Some would challenge the non-specific symptoms of "gas," "constipation" and "excessive crying," as being necessarily "allergic." And so it is that the term "allergy" should be used only when there is clear evidence of an immune mechanism. In a future eolumn we will distinguish other kinds of adverse, but non-allergic manifestations. 'Oiai, he ha'āwi mai nei i he mau ninau ola, ke 'olu'olu.

Table 1. Occurrence of "Allergy" in 128 Infants Fed Four Low-Allergenic Diets Breast Soy Breast-Soy Combined Total A NA ? A NA ? A NA ? A NA ? Poi 0 7 1 3 38 4 2 16 2 5 61 7 73 6.8% 84% 9.6% 100% Rice 0 6 0 0 23 7 4 11 4 4 40 11 55 7.3% 73% 20% 100% A="Allergy" NA="No allergy" ?=Not sure Total 128