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Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2021. [DOI: 10.1007/978-3-030-36335-2_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Fragrance inhalation and adverse health effects: The question of causation. Regul Toxicol Pharmacol 2019; 104:151-156. [PMID: 30904429 DOI: 10.1016/j.yrtph.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 02/18/2019] [Accepted: 03/16/2019] [Indexed: 12/28/2022]
Abstract
The toxicology of fragrance materials is largely well understood. Although most are benign, a minority have the potential to cause adverse health effects, notably allergic contact dermatitis resulting from skin sensitization. As a consequence, industry guidelines have banned certain materials and strictly limited the use of others. Recently, data have been published that have been interpreted to suggest that inhalation of fragrances is associated with the occurrence of a variety of health effects, ranging from headaches to asthma attacks. In this review, the evidence basis for these assertions is examined critically and the biological basis and mechanistic plausibility for causation by fragranced products of these health effects is explored. This review concludes that respiratory effects, including irritation and allergy appear highly unlikely to occur by this route. While some sensory/psychosomatic effects are possible, this does not explain the very high rates of adverse effects reported in the recently published questionnaire studies, which this review concludes are more likely to be attributed to methodological weaknesses. Ultimately, it is concluded that adverse health effects arising from fragrance inhalation are uncommon and remain to be identified and confirmed by methodologically rigorous epidemiological investigations supported by a convincing biological and mechanistic basis.
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Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2019. [DOI: 10.1007/978-3-319-72451-5_23-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Comorbidity and Multimorbidity of Asthma and Allergy and Intolerance to Chemicals and Certain Buildings. J Occup Environ Med 2018; 59:80-84. [PMID: 28045802 DOI: 10.1097/jom.0000000000000930] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES We tested the hypothesis of high comorbidity between asthma/allergy and chemical intolerance (CI) and between asthma/allergy and building intolerance (BI), and high multimorbidity between asthma/allergy, CI, and BI. METHODS Population-based questionnaire data were used from 530 participants with asthma/allergy (allergic asthma, nonallergic asthma, allergic rhinitis, and/or atopic dermatitis), 414 with self-reported and 112 with physician-diagnosed CI, and 165 with self-reported and 47 with physician-diagnosed BI. Separate reference groups were formed for each of the five case groups. RESULTS Adjusted odds ratios varied from 4.6 to 13.1 for comorbidity, and from 6.6 to 46.4 for multimorbidity. CONCLUSION The large comorbidity and multimorbidity between asthma/allergy, CI, and BI evokes the question as to whether there are similarities in underlying mechanisms between these conditions.
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Weinberg JL, Flattery J, Harrison R. Fragrances and work-related asthma-California surveillance data, 1993-2012. J Asthma 2017; 54:1041-1050. [PMID: 28332885 DOI: 10.1080/02770903.2017.1299755] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Fragrance chemicals are used in a large array of products. Workers may be exposed to these chemicals in the workplace directly when used as air fresheners, or indirectly in personal care products used by coworkers or others. This study characterizes work-related asthma (WRA) cases associated with fragrance exposures in California workplaces from 1993 through 2012. METHODS We used the California Work-Related Asthma Prevention Program's surveillance database to identify individuals with physician-diagnosed WRA associated with the use of air fresheners and scented personal care products (perfumes, colognes, etc.). Cases were classified using previously published, standardized surveillance methods. RESULTS Perfume was the ninth most common exposure identified from 1993 through 2012. A total of 270 WRA cases associated with fragrance exposure were reported during this period, representing 3.8% of all confirmed cases. These 270 cases included 242 associated with perfume or cologne, 32 associated with air freshener, and 4 associated with both. Similar to non-fragrance cases, nearly a quarter of fragrance-associated cases were classified as new-onset asthma. Fragrance-associated cases were significantly more likely to be in office, health, and education jobs than non-fragrance-associated cases. When compared to non-fragrance cases, fragrance cases were significantly more likely to be female (94% vs 62%) and be classified as having work-aggravated asthma (38% vs 20%), yet had similar outcomes compared with cases associated with other exposures. CONCLUSIONS Our surveillance data show that fragrance use in the workplace is associated with WRA. Prevention methods include employee education, enforced fragrance-free policies, well-designed ventilation systems, and good building maintenance.
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Affiliation(s)
- Justine Lew Weinberg
- a Public Health Institute , Contractors to the California Department of Public Health , Richmond , CA , USA
| | | | - Robert Harrison
- b California Department of Public Health , Richmond , CA , USA
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Gibson PR, Lockaby SD, Bryant JM. Experiences of persons with multiple chemical sensitivity with mental health providers. J Multidiscip Healthc 2016; 9:163-72. [PMID: 27103817 PMCID: PMC4827900 DOI: 10.2147/jmdh.s100688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
In this paper, we summarize the results of an online survey of persons in the United States with chemical intolerance/multiple chemical sensitivity who sought help from mental health providers, including counselors, psychologists, psychiatrists, and others. Respondents reported on their most recent contact with a provider, describing reasons for the contact, accommodations requested and received, and suggestions for how the experience could be more helpful. Overall, though clients were accommodated in small ways, some received no accommodation, and many felt that the providers needed to be more knowledgeable regarding chemical intolerance. Results are discussed in terms of the importance of providers becoming more aware of multiple chemical sensitivity and more willing to make their services accessible to these clients.
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Affiliation(s)
- Pamela Reed Gibson
- Department of Psychology, James Madison University, Harrisonburg, VA, USA
| | - Sharon D Lockaby
- Department of Psychology, James Madison University, Harrisonburg, VA, USA
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Jensen-Jarolim E, Roth-Walter F, Leitner E, Buchleitner S, Vogelsang H, Kinaciyan T. Prime and boost aerosol exposure via fog machine or shisha smoke followed by cinnamon hypersensitivity and anaphylaxis to spiced food. World Allergy Organ J 2016; 9:4. [PMID: 26839630 PMCID: PMC4730641 DOI: 10.1186/s40413-016-0091-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 01/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cinnamon aldehyde (alias cinnamaldehyde) is widely used in food, textile or cosmetic industry. It is mostly associated with contact allergy, but immediate type allergies have been reported. The present study was triggered by a case of anaphylactic events to cinnamon in food and upon skin prick test. We investigated a possible correlation of exposure to a disco fog machine and/or shisha consumption with immediate type hypersensitivity to cinnamon aldehyde in the patient and healthy volunteers. METHODS & RESULTS In both fog machines and shisha pipes heating of glycerol-based fluids before evaporation renders chemical transversion to malodorous acrolein. Therefore, both methods are frequently operated with aroma additives. Cinnamon aldehyde and derivatives could be detected by gas chromatography in sampled fog flavored with cola fragrance. The patient as well as healthy (mostly female) volunteers were skin prick tested using cinnamon aldehyde diluted in 0.9 % NaCl, Vaseline® or fog fluid. Persons with a history of exposure to disco fog or shisha (n = 10, mean 32.8 years) reacted with a significantly larger wheal and flare reaction in the skin test (p = 0.0115, p = 0.0146, or p = 0.098) than the non-exposed (n = 8, mean 37.3 years). Both groups were gender matched, but differed in the mean age by 4.5 years. This reaction was specific as compared to skin reactivity to cinnamon alcohol, with only a trend to higher reactivity in exposed persons (ns). CONCLUSION From our data we conclude that hapten fragrances such as cinnamon aldehyde may during heating in glycerol fluids associate to complete antigens and via inspiration lead to specific immediate type hypersensitivity. In some cases the hypersensitivity may be unmasked by spiced food containing cinnamon aldehyde or related chemicals, and lead to severe adverse reactions.
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Affiliation(s)
- Erika Jensen-Jarolim
- Institute of Pathophysiology and Allergy Research, Center of Pathophysiology, Infectiology and Immunology, Medical University Vienna, Vienna, Austria ; AllergyCare, Allergy Diagnosis and Study Center, Vienna, Austria ; Comparative Medicine, The Interuniversity Messerli Research Institute, Univ. of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Franziska Roth-Walter
- Comparative Medicine, The Interuniversity Messerli Research Institute, Univ. of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Erich Leitner
- Institute of Analytical Chemistry and Food Chemistry, Graz University of Technology, Graz, Austria
| | - Stefan Buchleitner
- Comparative Medicine, The Interuniversity Messerli Research Institute, Univ. of Veterinary Medicine Vienna, Medical University Vienna and University Vienna, Vienna, Austria
| | - Harald Vogelsang
- Divison of Gastroenterology, Univ. Clinic of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Tamar Kinaciyan
- Division of Immunology, Allergy and Infectious Diseases, Department of Dermatology, Medical University Vienna, Währinger G. 18-20, 1090 Vienna, Austria
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Tageldin M, Raafat H, Elassal G, Salah Eldin W. Influence of indoor respiratory irritants on the course of bronchial asthma. EGYPTIAN JOURNAL OF CHEST DISEASES AND TUBERCULOSIS 2014. [DOI: 10.1016/j.ejcdt.2014.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Sancho AI, Wangorsch A, Jensen BM, Watson A, Alexeev Y, Johnson PE, Mackie AR, Neubauer A, Reese G, Ballmer-Weber B, Hoffmann-Sommergruber K, Skov PS, Vieths S, Mills ENC. Responsiveness of the major birch allergen Bet v 1 scaffold to the gastric environment: Impact on structure and allergenic activity. Mol Nutr Food Res 2011; 55:1690-9. [DOI: 10.1002/mnfr.201100025] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 04/19/2011] [Accepted: 05/22/2011] [Indexed: 11/05/2022]
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Berg ND, Linneberg A, Thyssen JP, Dirksen A, Elberling J. Non-allergic cutaneous reactions in airborne chemical sensitivity--a population based study. Int J Hyg Environ Health 2011; 214:239-45. [PMID: 21324740 DOI: 10.1016/j.ijheh.2011.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 12/10/2010] [Accepted: 01/15/2011] [Indexed: 12/01/2022]
Abstract
Multiple chemical sensitivity (MCS) is characterised by adverse effects due to exposure to low levels of chemical substances. The aetiology is unknown, but chemical related respiratory symptoms have been found associated with positive patch test. The purpose of this study was to investigate the relationship between cutaneous reactions from patch testing and self-reported severity of chemical sensitivity to common airborne chemicals. A total of 3460 individuals participating in a general health examination, Health 2006, were patch tested with allergens from the European standard series and screened for chemical sensitivity with a standardised questionnaire dividing the participants into four severity groups of chemical sensitivity. Both allergic and non-allergic cutaneous reactions--defined as irritative, follicular, or doubtful allergic reactions--were analysed in relationship with severity of chemical sensitivity. Associations were controlled for the possible confounding effects of sex, age, asthma, eczema, atopic dermatitis, psychological and social factors, and smoking habits. In unadjusted analyses we found associations between allergic and non-allergic cutaneous reactions on patch testing and the two most severe groups of self-reported sensitivity to airborne chemicals. When adjusting for confounding, associations were weakened, and only non-allergic cutaneous reactions were significantly associated with individuals most severely affected by inhalation of airborne chemicals (odds ratio = 2.5, p = 0.006). Our results suggest that individuals with self-reported chemical sensitivity show increased non-allergic cutaneous reactions based on day 2 readings of patch tests.
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Affiliation(s)
- Nikolaj Drimer Berg
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Denmark.
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Elberling J. Respiratory Symptoms from Fragrances and the Link with Dermatitis. Contact Dermatitis 2011. [DOI: 10.1007/978-3-642-03827-3_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Of the world but not in it: barriers to community access and education for persons with environmental sensitivities. Health Care Women Int 2010; 31:3-16. [PMID: 20390633 DOI: 10.1080/07399330903042823] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
In this article I explore community access-primarily the lack thereof-for persons with disabling environmental sensitivities (ESs). Respondents with chemical and electrical sensitivities described their level of access to common community resources that most persons take for granted, including communities of worship, grocery stores, health food stores, community meetings, public libraries, the homes of extended family members and friends, offices of dentists and medical doctors, public parks, and classes at their local universities. Most had tentative access at best. In addition, participants listed the disability barriers that most restricted them from public participation. Results are described using both quantitative and qualitative data and the problem is analyzed within the context of industrial capitalism's influence upon institutions.
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Holst H, Arendt-Nielsen L, Mosbech H, Vesterhauge S, Elberling J. The capsaicin cough reflex in patients with symptoms elicited by odorous chemicals. Int J Hyg Environ Health 2009; 213:66-71. [PMID: 19773199 DOI: 10.1016/j.ijheh.2009.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 08/10/2009] [Accepted: 08/25/2009] [Indexed: 11/28/2022]
Abstract
Patients with multiple chemical sensitivity and eczema patients with airway symptoms elicited by odorous chemicals have enhanced cough reflex to capsaicin when applying the tidal breathing method. The aims of the present study were to test whether the capsaicin induced cough reflex was enhanced when applying the single breath inhalation method in similar groups of patients with symptoms related to odorous chemicals e.g. other persons wearing of perfume; and to investigate to what extent the reporting of lower airway symptoms influenced the cough reflex. Sixteen patients fulfilling Cullen's criteria for multiple chemical sensitivity and 15 eczema patients with airway symptoms elicited by odorous chemicals were compared with 29 age-matched, healthy controls. We measured C5--the capsaicin concentration causing five coughs or more--using the single breath inhalation test. No difference was found between groups in age, body mass index or pulmonary function. The median C5 were 129 micromol/L (control group), 48 micromol/L (multiple chemical sensitivity patients), 32 micromol/L (eczema patients). The reporting of lower airway symptoms from odorous chemicals was significantly (p<0.05) correlated to increased cough reflex sensitivity to capsaicin, independent of patient group or co-existence of asthma. The results suggest that the C5 is not reliable for diagnosing MCS but C5 can be used to verify presence of lower airway symptoms related to odorous chemicals.
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Affiliation(s)
- H Holst
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Denmark
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Elberling J, Lerbaek A, Kyvik KO, Hjelmborg J. A twin study of perfume-related respiratory symptoms. Int J Hyg Environ Health 2009; 212:670-8. [PMID: 19502109 DOI: 10.1016/j.ijheh.2009.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/05/2009] [Accepted: 05/11/2009] [Indexed: 10/20/2022]
Abstract
Respiratory symptoms from environmental perfume exposure are main complaints in patients with multiple chemical sensitivities and often coincide with asthma and or eczema. In this population-based twin study we estimate the heritability of respiratory symptoms related to perfume and if co-occurrences of the symptoms in asthma, atopic dermatitis, hand eczema or contact allergy are influenced by environmental or genetic factors common with these diseases. In total 4,128 twin individuals (82%) responded to a questionnaire. The heritability of respiratory symptoms related to perfume is 0.35, 95%CI 0.14-0.54. Significant associations (p<0.05) between perfume-related respiratory symptoms and asthma, atopic dermatitis, hand eczema or contact allergy are not attributable to shared genetic or shared environmental/familial factors, except possibly for atopic dermatitis where genetic pleiotropy with respiratory symptoms to perfume is suggested by an estimated genetic correlation of 0.39, 95%CI 0.09-0.72.
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Affiliation(s)
- J Elberling
- The Danish Research Centre for Chemical Sensitivities, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Ledreborg Alle 40, 2.th, DK-2820 Gentofte, Denmark.
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Mechanisms of increased airway sensitivity to occupational chemicals and odors. Curr Opin Allergy Clin Immunol 2009; 8:135-9. [PMID: 18317021 DOI: 10.1097/aci.0b013e3282f647ec] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Airway symptoms induced by chemicals and odors are common problems that are also reported after contact with substances normally regarded as nontoxic. This article reviews current findings and opinions regarding mechanisms of increased airway sensitivity to occupational chemicals and odors. RECENT FINDINGS Individuals exposed to organic solvents during work had more nasal irritation and lower threshold to pyridine odor compared with a nonexposed control group. Six percentage of a general population in Sweden had pronounced airway chemical sensitivity and augmented capsaicin cough sensitivity, known to reflect the sensory nerve reactivity of the airways. The cough sensitivity was associated with changed levels of nerve growth factor in nasal lavage and such patients had longstanding symptoms influencing their working capacity. Positron emission tomography activation studies with several different odorants showed in patients with odor-associated symptoms an odorant-related increase in activation of the anterior cingulate cortex and cuneus-precuneus in comparison with a control group. SUMMARY In subgroups of individuals with airway symptoms induced by chemicals and odors, there seems to be a sustainable physiological mechanism behind the reactions. An increased vulnerability to stress cannot be neglected as a confounding factor in some sensitive individuals.
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Buckley DA, Basketter DA, Kan-King-Yu D, White IR, White JLM, McFadden JP. Atopy and contact allergy to fragrance: allergic reactions to the fragrance mix I (the Larsen mix). Contact Dermatitis 2009; 59:220-5. [PMID: 18844697 DOI: 10.1111/j.1600-0536.2008.01373.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND The relationship between an atopic diathesis and contact sensitization to fragrances is unclear. OBJECTIVE To investigate whether there is an association between atopy and allergy to fragrance mix I (FM I). PATIENTS/METHODS The computerized files of patients patch tested to FM I at St John's Institute of Dermatology (1980-2004) were reviewed. Demographic details recorded for all patch-tested patients included age, sex, date of testing, history of current or previous atopic eczema (AE), history of current or previous asthma nor hay fever (A/HF), family history (FH) of any type of atopy, and any positive patch tests. RESULTS About 8.4% of females (1713/20 338) and 6.6% of males (903/13 734) were allergic to FM I. About 8.95% (101/1129) of females with AE were allergic to FM I versus 8.63% (619/7171) of females who had neither AE and A/HF nor FH (non-atopics) (P = 0.72). About 5.6% (40/710) of males with AE were positive to FM I versus 6.9% (427/6201) of male non-atopics (P = 0.23). There was a striking increase in AE and A/HF during this 25-year period (P < 0.0001). CONCLUSIONS We found no association between atopy and allergy to FM I. There has been a marked increase in atopy in individuals referred for patch testing in the past 25 years.
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Affiliation(s)
- Deirdre A Buckley
- St John's Institute of Dermatology, St Thomas' Hospital, London SE1 7EH, UK.
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