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While limited formal research exists on combination protocols, clinical experience and mechanistic understanding provide guidance on potentially synergistic approaches

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Folic acid, on the other hand, has multiple biochemical roles like conversion of homocysteine to methionine, serine to glycine and generation of one-carbon transfer compounds for purine and pyrimidine synthesis

In practice, we suggest a stepwise approach to diagnose MCAS starting with a thorough assessment of the episodic symptoms to judge if they qualify as typical symptoms or signs of severe and recurrent systemic MCA (Fig