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As I've discussed in my article Hidden Infections and Mast Cell Activation Syndrome, common culprits include: Tick-borne infections (Lyme disease, Bartonella, Babesia) Viral infections (especially herpesviruses like Epstein-Barr) Parasitic infections Chronic sinusitis Gut infections or dysbiosis 3

However, the quality of evidence is low due to the limited number of randomized controlled studies, small sample sizes and the limited studies in adults (87)

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