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GI side effects such as nausea, vomiting and reflux are most common in the early weeks of therapy and can lower oral pH, promoting enamel erosion and changes to the oral microbiome
After four weeks, patients increase to 0.5mg weekly for another four weeks, then to the maintenance dose of 1mg or 2mg weekly depending on response and tolerance
Oxidative stress is a potent, direct trigger for mast cell degranulation
Tornehave et al., 2008) (Figure 1)
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