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Mast cells can be activated by complement proteins, neuropeptides (including substance P, which is why stress and anxiety are common MCAS triggers), certain medications, physical stimuli (heat, cold, pressure, vibration), and directly by the toll-like receptors (TLR2 and TLR4) that recognize microbial compounds including, as research has established, certain mycotoxins found in improperly processed food products including coffee [ 7 ]

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The practical low-dose requirement is therefore three vials

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