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Castagna J, Chasset F, Autegarden JE, Le Thai C, Amsler E, Barbaud A, Soria A. Assessing delayed penicillin hypersensitivity using the PENFAST+ score. Front Allergy 2023; 4:1302567. [PMID: 38026134 PMCID: PMC10680989 DOI: 10.3389/falgy.2023.1302567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Approximately 10% of individuals report a suspected allergy to penicillin, but according to allergy work-ups, only 10%-15% of them are truly allergic. A clinical decision score, the PEN-FAST, was developed and validated to identify adults with low-risk penicillin allergy. Objectives The objective of this study was to improve the performance of the PEN-FAST score, particularly for those with delayed hypersensitivity (HS), by improving the negative predictive value. Methods STEP 1: Retrospective evaluation of the PEN-FAST score in patients with proven immediate and delayed penicillin allergy. STEP 2: Identification of additional criteria among Step 1 patients misclassified by PEN-FAST score. Development of the PEN-FAST+ score using multivariable logistic regression in a prospective cohort of patients with a suspicion of HS to penicillin. STEP 3: Comparison of diagnostic performances of PEN-FAST and PEN-FAST+ scores. Results The PEN-FAST score showed limitations in predicting the relapse of immediate skin HS or delayed maculopapular exanthema, with 28.6% and 38.4% of patients misclassified, respectively. We identified two potential additional criteria: skin rash lasting more than 7 days and immediate reaction occurring in less than 1 h (generalized or localized on palmoplantar area or scalp itching/heat feeling). A total of 32/252 (12.7%) patients were confirmed to be allergic to penicillin. With PEN-FAST, 37% of patients (n = 10) with delayed allergic penicillin HS were misclassified. With PEN-FAST+, 3 patients with delayed HS confirmed by a ST (11.1%) were misclassified. The AUC was significantly higher for PEN-FAST+ than PEN-FAST (85% vs. 72%, p = 0.03).
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Affiliation(s)
- Julie Castagna
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - François Chasset
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Centre d’Immunologie et de Maladies Infectieuses, Cimi-Paris, INSERM, Paris, France
| | - Jean-Eric Autegarden
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Claire Le Thai
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Emmanuelle Amsler
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Annick Barbaud
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- INSERM, Institut Pierre Louis d’Epidémiologie et de Sante Publique, Paris, France
| | - Angèle Soria
- Médecine Sorbonne Université, Service de dermatologie et d’allergologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
- Centre d’Immunologie et de Maladies Infectieuses, Cimi-Paris, INSERM, Paris, France
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Mascitti H, Gaouar H, Amsler E, Autegarden JE, Bayrou O, De Risi-Pugliese T, Haddad T, Hamelin A, Mathelier-Fusade P, Pecquet C, Thetis M, Kurihara F, Soria A, Barbaud A. Tolerance of Iodixanol, a nonionic, isosmolar contrast agent in case of immediate hypersensitivity reactions to radiocontrast media. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Chiron A, Gaouar H, Autegarden JE, Amsler E, Barbaud A, Soria A. Cross-reactivity with third and second generation cephalosporins in truly penicillin allergic patients. World Allergy Organ J 2020. [DOI: 10.1016/j.waojou.2020.100245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Chiron A, Gaouar H, Autegarden JE, Amsler E, Barbaud A, Soria A. Allergy to third- and second-generation cephalosporins in confirmed penicillin-allergic patients. J Allergy Clin Immunol Pract 2020; 8:2409-2411.e3. [PMID: 32268214 DOI: 10.1016/j.jaip.2020.03.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/21/2020] [Accepted: 03/10/2020] [Indexed: 11/15/2022]
Affiliation(s)
- Andrada Chiron
- Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Universités, Paris, France.
| | - Hafida Gaouar
- Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Universités, Paris, France
| | - Jean-Eric Autegarden
- Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Universités, Paris, France
| | - Emmanuelle Amsler
- Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Universités, Paris, France
| | - Annick Barbaud
- Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Universités, Paris, France
| | - Angèle Soria
- Service de Dermatologie et d'Allergologie, Hôpital Tenon, Paris HUEP, APHP, Paris, France; Sorbonne Universités, Paris, France; Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris), INSERM U1135, Paris, France
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Soria A, Masson N, Vial-Dupuy A, Gaouar H, Amsler E, Chollet-Martin S, Nicaise-Roland P, Autegarden JE, Barbaud A. Allergological workup with half-dose challenge in iodinated contrast media hypersensitivity. Allergy 2019; 74:414-417. [PMID: 30353926 DOI: 10.1111/all.13638] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Affiliation(s)
- Angèle Soria
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
- Centre d'Immunologie et des Maladies Infectieuses - Paris (Cimi-Paris); INSERM U1135; Paris France
| | - Nathalie Masson
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Amandine Vial-Dupuy
- Service de Pneumologie et d'Allergologie; Hôpital Saint Joseph; Paris France
| | - Hafida Gaouar
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Emmanuelle Amsler
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Sylvie Chollet-Martin
- Hôpitaux Universitaires Paris Nord Val de Seine; Hôpital Bichat; Unité d'Immunologie; Auto-immunité et Hypersensibilités; Paris France
- INSERM; UMR 996; UFR de Pharmacie; Université Paris-Sud; Châtenay-Malabry France
| | - Pascale Nicaise-Roland
- Hôpitaux Universitaires Paris Nord Val de Seine; Hôpital Bichat; Unité d'Immunologie; Auto-immunité et Hypersensibilités; Paris France
| | - Jean-Eric Autegarden
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
| | - Annick Barbaud
- Service de Dermatologie et d'Allergologie; Hôpital Tenon; Paris HUEP; APHP; Paris France
- Sorbonne Universités; Paris France
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Abstract
BACKGROUND About 10% of subjects report suspected penicillin allergy, but 85-90% of these patients are not truly allergic and could safely receive beta-lactam antibiotics Objective: To design and validate a clinical decision-making algorithm, based on anamnesis (chronology, severity, and duration of the suspected allergic reactions) and reaching a 100% sensitivity and negative predictive value, to assess allergy risk related to a penicillin prescription in general practise. STUDY DESIGN AND METHODS All patients were included prospectively and explorated based on ENDA/EAACI recommendations. Results of penicillin allergy work-up (gold standard) were compared with results of the algorithm. RESULTS Allergological work-up diagnosed penicillin hypersensitivity in 41/259 patients (15.8%) [95% CI: 11.5-20.3]. Three of these patients were diagnosed as having immediate-type hypersensitivity to penicillin, but had been misdiagnosed as low risk patients using the clinical algorithm. Thus, the sensitivity and negative predictive value of the algorithm were 92.7% [95% CI: 80.1-98.5] and 96.3% [95% CI: 89.6-99.2], respectively, and the probability that a patient with true penicillin allergy had been misclassified was 3.7% [95% CI: 0.8-10.4]. CONCLUSIONS Although the risk of misclassification is low, we cannot recommend the use of this algorithm in general practice. However, the algorithm can be useful in emergency situations in hospital settings. Key messages True penicillin allergy is considerably lower than alleged penicillin allergy (15.8%; 41 of the 259 patients with suspected penicillin allergy). A clinical algorithm based on the patient's clinical history of the supposed allergic event to penicillin misclassified 3/41 (3.7%) truly allergic patients.
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Affiliation(s)
- Angèle Soria
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France.,b Immunology and Infectious diseases Center - Paris (Cimi-Paris) , Sorbonne University , Paris , France.,c INSERM U1135, Cimi-Paris , Paris , France
| | - Elodie Autegarden
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France
| | - Emmanuelle Amsler
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France
| | - Hafida Gaouar
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France
| | - Amandine Vial
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France
| | - Camille Francès
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France
| | - Jean-Eric Autegarden
- a Department of Dermatology and Allergology , Tenon Hospital, APHP , Paris , France
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Frapsauce C, Berthaut I, de Larouziere V, d'Argent EM, Autegarden JE, Elloumi H, Antoine JM, Mandelbaum J. Successful pregnancy by insemination of spermatozoa in a woman with a human seminal plasma allergy: should in vitro fertilization be considered first? Fertil Steril 2010; 94:753.e1-3. [PMID: 20172516 DOI: 10.1016/j.fertnstert.2010.01.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/07/2010] [Accepted: 01/11/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To raise the possibility that pregnancy can be obtained by assisted reproductive techniques in patients with human seminal plasma allergy. DESIGN Case report. SETTING University hospital. PATIENT(S) A woman consulted for a 3-year primary infertility. She reported lack of intercourse because of a seminal plasma allergy. INTERVENTION(S) One intrauterine insemination associated with antihistamine treatment was performed with carefully washed spermatozoa. RESULT(S) Immediately after the insemination, the patient had an allergic reaction treated by steroids. Fortunately, this single attempt led to a successful pregnancy, and the patient gave birth to a healthy girl. CONCLUSION(S) Pregnancies can be obtained in patients with seminal plasma hypersensitivity by means of intrauterine insemination. However, serious complications may occur after performing intrauterine insemination, which is not a totally reliable method to prevent an allergic reaction. Thus a multidisciplinary team should follow such patients carefully and watch for the potential risks and side effects. In vitro fertilization may represent the more cautious option.
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Affiliation(s)
- Cynthia Frapsauce
- Department of Histology and Biology of Reproduction, Tenon Hospital (Assistance Publique Hôpitaux de Paris), Paris, France.
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Pecquet C, Autegarden JE, Kural-Menasche S, Perez G, Menasche P, Sanson-LePors MJ, Abuaf N, Leynadier F. [Anaphylactic reactions to aprotinin: intradermal diagnostic tests] . Ann Fr Anesth Reanim 2000; 19:755-7. [PMID: 11200765 DOI: 10.1016/s0750-7658(00)00318-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
A 66-year-old patient, undergoing heart surgery, developed an anaphylactic reaction following the first administration of a test-dose of aprotinin. Skin tests were performed six months later. Prick-tests with 10(-2) and 10(-1) aprotinin dilutions were negative but intradermal reaction with a 10(-3) dilution was clearly positive. The level of aprotinin specific IgE was high, both in the serum obtained before surgery and in the one sampled on the day of the testing. As no reaction was observed during the tests, skin-testing and specific IgE appear to be an interesting alternative to a potentially dangerous test-dose, but they both need further evaluation.
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Affiliation(s)
- C Pecquet
- Centre d'allergologie, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France
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Autegarden JE, Leynadier F. [Allergy to television]. Rev Pneumol Clin 2000; 56:331. [PMID: 11139764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- J E Autegarden
- Centre d'Allergologie, Hôpital Tenon, 4, rue de la Chine, 75020 Paris
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Turjanmaa K, Palosuo T, Alenius H, Leynadier F, Autegarden JE, André C, Sicard H, Hrabina M, Tran TX. Latex allergy diagnosis: in vivo and in vitro standardization of a natural rubber latex extract. Allergy 1997; 52:41-50. [PMID: 9062628 DOI: 10.1111/j.1398-9995.1997.tb02544.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
For the diagnosis of IgE-mediated (immediate) hypersensitivity to natural rubber latex (NRL), skin prick testing with extracts of latex gloves has been widely used, but such extracts are difficult to standardize. The present study aimed to produce on an industrial scale an NRL extract from freshly collected NRL and to evaluate, calibrate, and standardize the extract by both in vivo and in vitro testing. The source material, latex of the rubber tree, Hevea brasiliensis (clone RRIM 600), was frozen immediately after collection in Malaysia and shipped in dry ice to Stallergènes SA, France. Protein and allergen profiles were analyzed by sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE), immunoblotting, isoelectric focusing (IEF), crossed immunoelectrophoresis (CIE), and crossed radioimmunoelectrophoresis (CRIE). Allergen quantification was effected by RAST inhibition. The capacity of the preparation to elicit immediate hypersensitivity reactions in vivo was measured by skin prick testing in 46 latex-allergic patients and 76 nonallergic control subjects. SDS-PAGE and immunoblot profiles of the extract and an NRL standard (E8) provided by the US Food and Drug Administration were almost identical, disclosing several distinct IgE-binding proteins with apparent molecular weights of 14, 20, 27, 30, and 45 kDa, conforming to reported molecular weights of several significant NRL allergens. An arbitrary index of reactivity (IR) of 100 was assigned to the extract at 1:200 dilution (w/v), having a protein content of 22 micrograms/ml. Skin prick testing of latex-allergic patients and controls using the extract at 100 IR revealed 93% sensitivity, 100% specificity, 100% negative predictive value, and 96% positive predictive value. In conclusion, a skin prick test reagent for diagnosis of type I NRL allergy was successfully standardized. The reagent was demonstrated to contain most, if not all, of the currently known clinically significant NRL allergens, and it showed high sensitivity and specificity.
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Affiliation(s)
- K Turjanmaa
- Department of Dermatology, Tampere University Hospital and Medical School, Finland
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Kekwick R, Bhambri S, Chabane MH, Autegarden JE, Levy DA, Leynadier F. The allergenic properties of fresh and preserved Hevea brasiliensis latex protein preparations. Clin Exp Immunol 1996; 104:337-42. [PMID: 8625530 PMCID: PMC2200425 DOI: 10.1046/j.1365-2249.1996.24731.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
The allergenic properties of the proteins of two lyophilized fractions of fresh natural rubber latex obtained by ultracentrifugation, the C serum and the sedimented bottom or lutoid fraction, have been compared with those of the serum proteins of two samples of high ammonia latex (HAL) [A]HALS obtained from HAL stored for more than 1 year, and [M]HALS derived from HAL stored for 6 weeks before ultracentrifugation and lyophilization. The most potent source of allergenic polypeptides both for skin prick testing of latex-sensitive patients and for immunoblots of their blood serum was the lutoid fraction of fresh latex. Skin prick tests and immunoblots of patients' sera showed that the allergenicity of the ammoniated latex decreased during storage. Skin prick tests using fractions of [A]HALS, C serum and lutoid proteins obtained after passage through a Sephacryl S300 column showed that the components of all three preparations which eluted in the largest volumes were almost equally effective in provoking the largest number of responses. Immunoblots of the sera of 43 latex-sensitive individuals showed that the majority (66%) of sera of the adult allergic patients reacted with a polypeptide of 19 kD. No characteristic pattern of binding latex polypeptides could be recognized in the sera from patients who were also asthmatic or from those who had an anaphylactic response to latex proteins.
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Affiliation(s)
- R Kekwick
- School of Biochemistry, University of Birmingham, UK
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Levy DA, Kekwick RG, Bhambri S, Autegarden JE, Leynadier F. Latex, an intriguing allergen. Int Arch Allergy Immunol 1995; 107:454-5. [PMID: 7613212 DOI: 10.1159/000237079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- D A Levy
- Hôpital Rothschild, Paris, France
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Godeau B, Paul M, Autegarden JE, Leynadier F, Astier A, Schaeffer A. Hypersensitivity to azathioprine mimicking gastroenteritis. Absence of recurrence with 6-mercaptopurine. Gastroenterol Clin Biol 1995; 19:117-9. [PMID: 7720971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Hypersensitivity mimicking gastroenteritis is a rare complication of azathioprine therapy for which the mechanism is unknown. We report a case of devastating diarrhoea and vomiting due to azathioprine treatment in which hypersensitivity to the imidazole moiety of azathioprine was demonstrated. This has important therapeutic implications: in this situation, 6-mercaptopurine, which is the portion of azathioprine responsible for the cytotoxic therapeutic effect, can be administered without recurrence of side-effects.
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Affiliation(s)
- B Godeau
- Service de Médecine Interne, Hôpital Henri-Mondor, Creteil
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Autegarden JE, Chabane MH, Haddad T, André C, Leynadier F. [Urinary leukotrienes after rapid desensitization to venom of hymenoptera]. Presse Med 1994; 23:1181. [PMID: 7971855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
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