Differences Between IgE and IgG Testing for Allergies and Sensitivities

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While feeding of milk is continued, a mixed diet should gradually be introduced, aimed at providing the energy, protein, minerals and vitamins needed by the child. With over 65, trained volunteers, Southern Baptist Disaster Relief is one of the largest disaster relief organizations in the US. There may be skin changes including flaky-paint dermatosis, hair changes, mental changes and hepatomegaly. The thyroid gland of each person should be examined both visually and by palpation to judge its size. Below is a summary:. Therefore, since every case is different, by following the correct sequence as revealed through Nutrition Response Testing, even the most complicated cases can be handled.

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Another problem is with medications. I have been lucky so far because I do not require any medications I have heard that some people get their medications specially compounded. When you require a medication, discuss your requirement for a corn-free product with your pharmacist.

There are usually several alternative sources of the drug you might require, and at least one will be corn-free and safe for you. A while ago I increased the amount of milk in my diet, mostly for the added calcium benefit. I started to develop severe skin eruptions on my face.

It took me quite some time to figure out that it was milk that was causing my problem. I called both Saputo and Parmalat Dairies and they confirmed that corn oil was the carrier in the Vitamins A and D required by law added to milk. I had no idea that there was corn oil in milk.

I e-mailed Health Canada regarding the addition of corn oil to the milk supply in Canada without proper labelling. The reply I received was that there was no way that corn oil could cause an allergic reaction since all of the protein had been removed. My skin tells me a different story. I have resigned myself to the fact that I will never be able to use milk products in my diet again. The answer from Health Canada is correct.

The amount of protein in the corn oil carrier of the fat-soluble vitamins added to commercial milk is so small that in most cases it is insufficient to cause an allergic reaction. However, if you think that additives in the milk are the cause of your skin eruptions, you should be able to obtain raw milk before the vitamins are added.

Some farms will supply you with raw milk before it is sent for processing and artificially fortified. You must boil the milk and cool it before consumption to ensure that any harmful micro-organisms are destroyed. This does not destroy any important nutrients such as calcium, and it would allow you to enjoy milk and its nutritional benefits once again.

However, the raw milk will not supply your requirements for vitamins A and D, so be sure to obtain your daily requirement of these vitamins from alternate sources see below. Sources of Vitamin A: Vitamin A from plant sources carotenoids can be found in dark green, leafy vegetables broccoli, swiss chard, kale, spinach, romaine lettuce, endive, Brussels sprouts and orange or yellow vegetables carrot, sweet potato, pumpkin, winter squash and fruits apricots, peaches, cantaloupe, papaya.

Animal sources of vitamin A retinol include liver, fish liver oils, milk, milk products, butter, eggs. Sources of Vitamin D: The main source of vitamin D is the action of sunlight on the skin. Half an hour in direct sunshine will supply the daily requirement for vitamin D for the average adult.

Food sources include egg yolk, liver, oily fish and fish liver oils. What do I do in case of an accidental ingestion of my allergenic food? The answer depends on the severity of your reaction. Monitor your reactions and if you develop any signs of allergy, such as throat tightening, breathing difficulty, hives, nausea and vomiting, immediately inject the adrenalin as you will have been instructed, dial emergency medical services, and proceed to the nearest hospital.

Take the rapid-acting antihistamine provided with the device if your doctor has recommended this. If your reactions to the ingested food are usually mild, and you have not been diagnosed with IgE-mediated allergy and have not been prescribed autoinjected adrenalin, your response is very unlikely to lead to a life-threatening situation.

Nevertheless you should monitor your reactions and act accordingly. If you develop any signs of an allergic response it is a good idea to take a quick-acting antihistamine, such as Benadryl. Your symptoms should subside fairly quickly. If the symptoms do start to escalate, however, seek medical advice immediately. As a general rule, an adverse reaction tends to resolve over a period of four days. It can be visualized as the mediator level decreasing each day by half.

The first response is the maximum level; Day 2 is half of Day 1; Day 3 is half of Day 2, and so on. By Day 4 all symptoms should have resolved.

For food intolerances such as histamine intolerance, where frequent use of antihistamine is contraindicated, alkaline salts have proven to be a very safe, natural way to control symptoms. Recipe for Alkaline Salts: Mix together in a small jar:.

Take half a teaspoonful of the mixture in a cup of warm water. Your reaction should subside fairly quickly. If necessary you can take another dose half an hour later. My 2 year-old son has eczema, which started when he was about 3 months of age.

I have heard that some food causes eczema. Can you please tell me which foods cause eczema so that I can stop feeding them to him? He is eating most foods now, and his eczema comes and goes.

Sometimes it is quite bad, especially when he visits his grandmother. They live in a fairly old house with lots of carpets and have three cats. He seems to become quite stuffed up and slightly wheezy when he goes to their place. You have actually given me some important information about your son, and have asked what seems to be a simple question, but which has a complex answer.

I will try to be brief:. First of all, it is important to understand that food does not cause eczema, nor does food cause allergy. Eczema or in medical terms, atopic dermatitis is one of the important symptoms that can result from an allergic reaction to food. Eczema can also occur as a response to an allergic reaction to environmental allergens such as dust mites, mold spores, animal dander, and plant pollens, among others.

Eczema as a symptom of food allergy seems to be much more frequent in early childhood than later in life. The first symptoms that alert health care providers and parents that a baby is allergic or atopic are in the digestive tract often exhibited as symptoms such as prolonged colic, vomiting, and diarrhea and in the skin eczema and hives.

In babies under the age of six months, eliminating the foods that are triggering symptoms often leads to a significant improvement in the eczema, and in some cases, total remission. In our experience in the Allergy Nutrition Clinic at Vancouver Hospital, the foods that most frequently trigger the onset of eczema in babies and children tend to be: Of course every baby is an individual, and may have been sensitized to foods other than those on the above list.

Unfortunately, we do not see the same degree of improvement in older children because after a year, environmental allergens dust mites, mold spores, pollens, animal dander begin to be as, or more, important than foods as a cause for the eczema.

Thereafter, whenever the baby encounters these allergens, the immune system is primed to respond with symptoms of allergy. Sometimes this allergy is eczema, but it can also be expressed as rhinitis nasal stuffiness and wheezing which can be a symptom of asthma when the allergens have sensitized tissues of the respiratory tract.

So, your 2 year-old is exhibiting signs of allergy, possibly to both foods and environmental allergens. This would explain the obvious increase in the severity of his eczema, and his rhinitis and wheezing, when he has been in an environment where the level of the allergens in his case dust and cat dander , are unusually high.

I would advise you to take your son to a pediatrician or pediatric allergist for allergy evaluation and RAST, which is a blood test that will demonstrate whether he has been sensitized to specific allergens, both in foods and in the environment. Skin testing is not advisable for children who have eczema, because their skin is already highly reactive and will frequently produce false positive results, as well as creating a possible route for sensitization to allergens in the test reagents.

Since your son is fairly young he might still be reacting adversely to some foods in his diet. A short time trial from two weeks to a month on a diet that excludes the most frequent food allergens eggs, milk and milk products, peanuts, tree nuts, soy, and green peas should show improvement in his symptoms if foods are playing a significant role in the eczema.

We do not want to put him at any nutritional risk as a result of removing important food groups such as milk and milk products from his diet at this critical stage of his development. My 14 month old son has been allergic to eggs since at least 12 months of age, when we first gave him egg in a cookie. He reacted to egg-containing foods with facial reddening. He has had eczema for many months.

Is this necessary, as I am already quite certain that he is allergic to egg? What is the recommendation for egg allergy and immunization? How do I know whether it is, or can be, anaphylactic as the reaction can be worse next time? That is why I do not want to try egg at home again. By the age of 14 months it is likely that your son is out-growing his early reactivity to egg, and it would be wise for him to undertake a direct challenge test to determine whether he still develops symptoms when he eats egg, since this is an ingredient in many nutritious foods which can be introduced now.

However, there is a risk of a severe reaction when egg is consumed because egg is one of the foods that has the potential to cause anaphylaxis in young children. Clearly, you do not want to risk this reaction at home. You could carry out a safe non-provocation preliminary test for egg allergy at home: If there is no sign of reddening or irritation at the site of application, apply a little to the outer border of his bottom lip not inside ; again wait for 20 minutes.

If there is no reddening, blistering, or irritation, it should be safe to proceed to a direct challenge. If there is no reaction the child is given a very small amount of egg yolk e. If no symptoms develop, give him? Although a small quantity of egg from the viral culture medium might contaminate vaccines such as the MMR and flu, there is very little reported evidence of anaphylactic reactions to the egg component of the vaccine, so most physicians seem to feel safe in administering these vaccines to egg-allergic children who have not had a severe reaction.

In the cases where anaphylactic reactions to egg ingestion have occurred, the physician may give the vaccine in small doses rather than all at once. Talk to your child's doctor or health clinic for their recommendations and policy on administering viral vaccines to egg-allergic children. Question For a number of years, starting in high school, I have been experiencing strange symptoms when I exercise vigorously, or play demanding sports.

My throat feels as if it is closing, and I am afraid of choking. My pulse becomes very rapid. I have to stop and rest before it subsides. Sometimes I feel very nauseated, become lightheaded and on two occasions developed tunnel vision with spots before my eyes. I have consulted my doctor, and have had stress tests and other heart function investigations, but so far he has not been able to tell me what is wrong. I am a year old college student.

If all the cardio-vascular investigations are normal, and no other cause for your symptoms has been found, it would be logical to investigate whether you might be experiencing food-associated exercise-induced anaphylaxis FAEIA. This is a rather rare condition, and differs from exercise-induced anaphylaxis in that the reaction does not occur with exercise alone — the offending allergenic food has to have been consumed prior to the exercise.

FAEIA is one of the most difficult food allergies to diagnose because the reaction does not immediately follow ingestion of the food, but occurs from one to four hours later while the person is exercising — usually vigorously. Sometimes there is no previous history of food allergy. The condition seems to occur most frequently when the person is asthmatic.

Sometime FAEIA can be associated with taking medications such as aspirin at the same time as the food, and alcohol can also make things worse.

I have prepared a Factsheet on this condition, which you might find helpful:. Food dependent exercise induced anaphylaxis. My twelve-month old son has diarrhea. His stool is always loose and unformed, and often he has several bowel movements a day. I am still breast-feeding, and we have added several solid foods to his diet. He had no problems with baby cereals, but his diarrhea seemed to start when we gave him table foods.

Do you think he is allergic to wheat? Or perhaps he has become allergic to milk? He drinks lots of fluids, and loves apple juice, so we decided to avoid the milk and give him apple and pear juice instead, but that has not helped the diarrhea — in fact it seems to have become worse. We have not yet given him orange juice because we heard that citrus fruits can cause allergies.

Because your son did not start to develop loose stool and diarrhea until he started to eat a wider range of foods, it is unlikely that he is allergic to milk, and lactose intolerance would be very unusual at his age unless he has had a recent digestive tract infection. A clue to his problem is that when you removed milk from his diet and substituted apple and pear juice, the diarrhea became worse.

This suggests that he may be exhibiting signs of fructose intolerance, or more accurately, fructose malabsorption, a condition that is not uncommon in early childhood. Apples and pears, unlike other fruits and their juices, contain more of a sugar called fructose than glucose most other fruits contain about the same quantity of fructose as glucose, which combine to make the disaccharide sugar, sucrose.

It is thought that immaturity in the system that transports the sugars across the digestive membrane into blood causes the large amount of fructose in apples and pears to be left behind in the small intestine. The fructose is thus undigested and causes problems when it moves into the large bowel.

Here it provides nourishment for the micro-organisms that live in the bowel, which ferment the sugar and cause the stool to be loose. Try avoiding all fruit juices for a while. Give him plenty of plain water, and milk should be OK, and continue to breast-feed. After about four weeks, if the diarrhea has cleared up, try juices other than apple or pear.

About two years ago I started to break out in hives, and my face became red and puffy, mostly after I ate in restaurants. Now I am often itchy, and break out in hives for no reason. I thought I was allergic to food and stopped eating sugar because my friend told me that it often causes allergies, but it does not seem to have helped.

Sometimes I get hives and a swollen face after eating, sometimes I wake up in the morning with my eyes swollen and my whole body itches. I seem to have heart palpitations, even when I am not particularly active. My heart races and I feel hot and clammy as if I might have a heart attack, or perhaps a panic attack. I also seem to have headaches more often than before. I went for allergy testing, but everything came back negative. I have never had allergies, but I wonder what is happening?

The symptoms you describe, and the type of pattern of onset, seems to suggest that you are dealing with a situation of histamine excess.

Excessive histamine, from a variety of different sources, will result in symptoms often indistinguishable from allergy. This is not surprising since the early symptoms of an allergic reaction are mediated by the histamine released during the progress of the allergic response.

The question, of course, is why are you experiencing symptoms of histamine excess now? I assume you had at least one course of antibiotics, although you do not give details of the infective micro-organism and the treatment you received.

The bacteria now in your intestines may be the types that make histamine from incompletely digested food materials that pass into the bowel. This can result in more histamine entering your body than previously, and augmenting both your natural histamine that we require for a various functions in the brain and digestive tract as well as processes in the immune system , and histamine in your diet.

It is not like an allergy where we can identify exactly which foods contain the allergen and avoid them — it is much more complicated. Histamine comes from many different sources — your body makes it, and the micro-organisms that live in your bowel also make it from food materials that are incompletely digested.

In addition, some foods themselves contain histamine naturally, and some ingredients in foods especially food additives like some food dyes and preservatives such as benzoates and sulphites cause the body to release more. It is the accumulated amount of histamine from all these sources that causes symptoms. So you see — it is not an easy job finding out which of these possible sources of histamine is the culprit in any given situation.

It is rarely a single food that is the cause, and avoiding one or two foods will rarely solve the problem. It is important that all histamine-rich foods be avoided in order to reduce the total amount of histamine entering the body in the diet. The reason that some people get symptoms of histamine excess and others do not is because there is a difference in the amount of specific enzymes to keep histamine levels in check that each person naturally produces. This can be an inherited trait, or may be affected by factors that are as yet completely understood.

We do know that certain medications can affect the process of histamine breakdown in some cases. However, we do not know of any process that will increase the amount of these enzymes that the body produces. All we can do is to intercept histamine before it causes symptoms, using antihistamines, and reduce the amount of histamine coming from our food by following a histamine-reduced diet.

In my clinical practice of managing food sensitivities I have encountered a large number of patients with exactly the kind of the symptoms that you describe, who have responded extremely well to a histamine-restricted diet. The basis of the diet is avoidance of foods that are rich in natural histamine; in particular, fermented foods in which bacterial activity during their manufacture produces histamine; foods that contain histamine, possibly as a result of the ripening process e.

Details of the diet can be found in my books: You will find further information on Histamine Intolerance in my Fact Sheet, and my published articles on the subject.

In addition, I have provided a number of resources from my media library including interviews, videos, and PowerPoint presentations on the topic for those of you who would like even more information. Please click on the links below to access them:. Outcome of a histamine-restricted diet based on chart audit. Journal of Nutritional and Environmental Medicine ;11 4: It feels like allergy; It looks like allergy; but it's not an allergy. Foods Matter Newsletter March Histamine Sensitivity Questions and Answers on more than 40 diverse aspects of histamine intolerance or sensitivity by Dr.

Janice Joneja in Foods Matter on-line publication. Histamine and Burning Mouth Syndrome. Histamine Intolerance Part 1. Histamine Intolerance Part 2. Factcsheet about using pea seedlings as a source of diamine oxidase and method for preparation in your own home:. A plant source of diamine oxidase. The scientific basis and method of preparation.

Histamine, Diamine oxidase and Probiotics: Data and research proposal. Histamine, Diamine oxidase, and Probiotics. My four-year old son has always been hyperactive, but sometimes his behaviour is almost uncontrollable. He runs around wildly, and hits his baby sister, and has even hit me.

I have heard that certain foods, especially sugar, can cause bad behaviour in children. Michael does seem to get worse when he has a lot of candies and pop. I have tried to limit his treats, but still he has days when he is impossible to live with.

How can I find out if food allergies are his problem? American College of Nutrition's 59th Annual Conference. Login , register or request a new password.

Newsletter Signup First Name: It is the most widely recognized nutrition certification by federal and state governments. It is the only non-dietetics credential and examination widely named in state nutrition licensure laws. It is l isted by the US Government's Department of Labor as an advanced nutrition credential in the definition of the "Dietetics and Nutritionists" profession in its Occupational Outlook Handbook.

It is l isted by the Centers for Medicare and Medicaid as among those potentially eligible to order therapeutic diets in hospitals. The CCN focuses on how foods are digested, absorbed, and assimilated, and ultimately how food affects the body biochemically.

Among the many aspects of nutrition research considered within this context are by-products of digestion, gastrointestinal health, neurotransmitter response, immune function, metabolic shifts and balance, allergic or sensitivity reactions, and systems and pathways of detoxification.

The CCN's approach to diet structure is developed according to what is best for the individual-not necessarily what is a standard recommendation for the general public at large, or for all people experiencing a particular health concern. Its emphasis is primarily on strategic risk management and mitigation, as well as developing policies and planning. The National Disaster Response Force is the government agency primarily responsible for emergency management during natural and man-made disasters , with specialized skills in search, rescue and rehabilitation.

This arrangement unites humanitarian and development partners with Government of Nepal and had identified 5 flagship priorities for sustainable disaster risk management.

If local arrangements are overwhelmed, pre-existing mutual-support arrangements are activated. These structures are defined by regulation, [] and explained in The Guide to the National Civil Defence Emergency Management Plan , roughly equivalent to the U.

New Zealand uses unique terminology for emergency management. Emergency management is rarely used, many government publications retaining the use of the term civil defence. Civil Defence Emergency Management is a term in its own right, defined by statute. For example, publications refer to the Canterbury Snow Event Disaster management in Pakistan revolves around flood disasters focusing on rescue and relief.

Federal Flood Commission was established in under Ministry of Water and Power to manage the issues of flood management on country-wide basis. The National Disaster Management Ordinance, and National Disaster Management Act, were enacted after Kashmir earthquake and Pakistan floods respectively to deal with disaster management. The primary central authority mandated to deal with whole spectrum of disasters and their management in the country is National Disaster Management Authority.

In addition each province along with FATA , Gilgit Baltistan and Pakistani administered Kashmir has its own provincial disaster management authority responsible for implementing policies and plans for Disaster Management in the Province.

Each District has its own District Disaster Management Authority for planning, coordinating and implementing body for disaster management and take all measures for the purposes of disaster management in the districts in accordance with the guidelines laid down by the National Authority and the Provincial Authority.

In the Philippines , the National Disaster Risk Reduction and Management Council is responsible for the protection and welfare of people during disasters or emergencies.

It is a working group composed of various government, non-government, civil sector and private sector organizations of the Government of the Republic of the Philippines. Headed by the Secretary of National Defense under the Office of Civil Defense, the NDRRMCs implementing organization , it coordinates all the executive branches of government, presidents of the leagues of local government units throughout the country, the Armed Forces of the Philippines , Philippine National Police , Bureau of Fire Protection which is an agency under the Department of Interior and Local Government , and the public and private medical services in responding to natural and manmade disasters, as well as planning, coordination, and training of these responsible units.

It is part of a broader effort by the federal authorities to re-establish national institutions. The Federal Parliament is now expected to deliberate on the proposed bill for endorsement after any amendments. In the Netherlands the Ministry of Security and Justice is responsible for emergency preparedness and emergency management on a national level and operates a national crisis centre NCC.

The country is divided into 25 safety regions veiligheidsregio. In a safety region, there are four components: The regional dispatch operates for police, fire department and the regional medical care. The dispatch has all these three services combined into one dispatch for the best multi-coordinated response to an incident or an emergency. And also facilitates in information management, emergency communication and care of citizens.

These services are the main structure for a response to an emergency. It can happen that, for a specific emergency, the co-operation with an other service is needed, for instance the Ministry of Defence , water board s or Rijkswaterstaat. The veiligheidsregio can integrate these other services into their structure by adding them to specific conferences on operational or administrative level. All regions operate according to the Coordinated Regional Incident Management system.

Following the fuel protests and severe flooding that same year, as well as the foot-and-mouth crisis in , the United Kingdom passed the Civil Contingencies Act CCA.

The CCA defined some organisations as Category 1 and 2 Responders, setting responsibilities regarding emergency preparedness and response. Disaster Management training is generally conducted at the local level, and consolidated through professional courses that can be taken at the Emergency Planning College. Diplomas, undergraduate and postgraduate qualifications can be gained at universities throughout the country. The Institute of Emergency Management is a charity, established in , providing consulting services for the government, media and commercial sectors.

Staff from five hospitals and three airports participated in the drill, and almost international observers assessed its effectiveness. Processes are then mapped to specific hazards or threats, with the manager looking for gaps, overlaps, and conflicts between processes.

Given these notions, emergency managers must identify, contemplate, and assess possible man-made threats and natural threats that may affect their respective locales. Thus, although similarities may exist, no two emergency plans will be completely identical.

Additionally, each locale has different resources and capacities e. This creates a plan more resilient to unique events because all common processes are defined, and it encourages planning done by the stakeholders who are closer to the individual processes, such as a traffic management plan written by a public works director.

In the United States, all disasters are initially local, with local authorities, with usually a police, fire, or EMS agency, taking charge. Many local municipalities may also have a separate dedicated office of emergency management OEM , along with personnel and equipment. If the event becomes overwhelming to the local government, state emergency management the primary government structure of the United States becomes the controlling emergency management agency. FEMA supports, but does not override, state authority.

The Citizen Corps is an organization of volunteer service programs, administered locally and coordinated nationally by DHS, which seek to mitigate disasters and prepare the population for emergency response through public education, training, and outreach. Most disaster response is carried out by volunteer organizations. It is typically the lead agency handling shelter and feeding of evacuees.

Religious organizations, with their ability to provide volunteers quickly, are usually integral during the response process. The largest being the Salvation Army , [] with a primary focus on chaplaincy and rebuilding, and Southern Baptists who focus on food preparation and distribution, [] as well as cleaning up after floods and fires, chaplaincy, mobile shower units, chainsaw crews and more. With over 65, trained volunteers, Southern Baptist Disaster Relief is one of the largest disaster relief organizations in the US.

Unaffiliated volunteers show up at most large disasters. To prevent abuse by criminals, and for the safety of the volunteers, procedures have been implemented within most response agencies to manage and effectively use these 'SUVs' Spontaneous Unaffiliated Volunteers.

The National Tribal Emergency Management Council NEMC is a non-profit educational organization developed for Tribal organizations to share information and best practices, as well as to discuss issues regarding public health and safety, emergency management and homeland security, affecting those under Indian sovereignty. The NRF allows the integration of federal resources with local, country, state, or tribal entities, with management of those resources to be handled at the lowest possible level, utilizing the National Incident Management System NIMS.

The Centers for Disease Control and Prevention offer information for specific types of emergencies, such as disease outbreaks, natural disasters and severe weather, chemical and radiation accidents, etc. The Emergency Preparedness and Response Program of the National Institute for Occupational Safety and Health develops resources to address responder safety and health during responder and recovery operations.

The Emergency Management Institute EMI serves as the national focal point for the development and delivery of emergency management training to enhance the capabilities of state , territorial, local , and tribal government officials; volunteer organizations; FEMA's disaster workforce; other Federal agencies; and the public and private sectors to minimize the impact of disasters and emergencies on the American public.

EMI curricula are structured to meet the needs of this diverse audience with an emphasis on separate organizations working together in all-hazards emergencies to save lives and protect property. Approximately 5, participants attend resident courses each year while , individuals participate in non-resident programs sponsored by EMI and conducted locally by state emergency management agencies under cooperative agreements with FEMA.

An Orientation to the Position" and provides background information on FEMA and the role of emergency managers in agency and volunteer organization coordination. It has trained more than 2. In emergency or disaster management the SMAUG model of identifying and prioritizing risk of hazards associated with natural and technological threats is an effective tool. The SMAUG model provides an effective means of prioritizing hazard risks based upon the aforementioned criteria in order to address the risks posed by the hazards to the avail of effecting effective mitigation , reduction, response and recovery methods.

Seriousness can be defined as "The relative impact in terms of people and dollars. Manageability can be defined as "the relative ability to mitigate or reduce the hazard through managing the hazard, or the community or both ". Hazards presenting a high risk and as such requiring significant amounts of risk reduction initiatives will be rated high.

Acceptability — The degree to which the risk of hazard is acceptable in terms of political, environmental, social and economic impact.

Urgency — This is related to the probability of risk of hazard and is defined in terms of how imperative it is to address the hazard []. Growth — This is the potential for the hazard or event to expand or increase in either probability or risk to community or both. Should vulnerability increase, potential for growth may also increase.

An example of the numerical ratings for each of the four criteria is shown below: From Wikipedia, the free encyclopedia. This section does not cite any sources. Please help improve this section by adding citations to reliable sources. Unsourced material may be challenged and removed. March Learn how and when to remove this template message.

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