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An intradermal skin test should be performed if there is a hypersensitivity risk

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The MTHFR enzyme plays a crucial role in the methylation process, where it converts folate (vitamin B9) from the foods we eat into its active form, methylfolate (L-5-MTHF)

Together, these findings highlight a distinct metabolic signature in ME/CFS, where energy production pathways may fail to respond efficiently to physical exertion, potentially driving exacerbation of symptoms seen in PEM

Larger patient cohorts with survival data will be needed to further define its prognostic significance