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Inclusion criteria: all participants must: be 65 years of age be attending a primary healthcare centre for consultation on some medical matter provide their informed consent to be included have a serum B12 concentration of 200 pg/ml at 4 months in over 70% of patients

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14 During the provocation phase, degranulation of effector cells, such as mast cells, induces allergic inflammation, and serotonin or 5-hydroxytryptamine is released in large amounts, resulting in acute gastrointestinal symptoms, including diarrhea

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