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Because of this highly individualized and unpredictable immunological response, patients with severe, highly reactive MCAS should introduce NAC with extreme caution and patience

Microb Biotechnol 2022, 15 (5), 15501560

PMC 2414278

Mercado et al

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The classic Russell mechanism involves the combination of two peroxyl radicals followed by the elimination of singlet oxygen and formation of one alcohol and one ketone