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Test your allergy IQ

True or false:

1. Allergies to pollen are more common than allergies to cats.
True:
Thirty-five million people are allergic to airborne pollen and suffer from upper respiratory symptoms. Approximately 10 million Americans are allergic to cats.

2. Breastfeeding protects a baby from developing allergies.
True. Many studies have shown that one of the best ways to prevent allergies and asthma is to breastfeed exclusively for at least 6 months and continue breastfeeding after that point. Mother's milk provides anti-inflammatory properties that reduce the risk of infections (which can act as allergy triggers). 25

3. Allergies are hereditary.
True
Allergies have a genetic component. If one parent has allergies, chances are 1 in 3 that each child will have an allergy. If both parents have allergies, it is much more likely (7 in 10) that their children will have allergies.

4. Allergies are not life threatening.
False
Although rare, some allergies can unfortunately be life threatening. For example, anaphylaxis is a severe allergic reaction that can lead to death if the individual is not treated immediately. Anaphylaxis affects many systems in the body, leading to itchy skin, swollen lips, tongue and throat, nausea and vomiting. It can lead to breathing difficulties, a drop in blood pressure, loss of consciousness, and finally death. Common causes of anaphylaxis include foods such as nuts and shellfish, insect stings, latex and some drugs, such as penicillin. Fortunately, anaphylaxis is uncommon.

5. Frequent exposure to an allergen—such as pollen, or to your cat—is a good way to desensitize yourself.
False
Deliberately exposing yourself to the substances you are allergic to will not cure your allergy. In fact, with regular exposure to allergens, you are more likely to make your allergy worse.

6. Most people outgrow their allergies.
False.
Unfortunately, allergies can develop at any age, and if you have allergies as an adult, they are likely to continue. Children with severe asthma are likely to continue to have asthma in adulthood, although some children do outgrow their allergies. Generally, the worse the symptoms of asthma in childhood, the more likely they will persist into adult life.

7. Pets with short hair are okay for allergy-sufferers to live with.
False
It's not an animal's fur that one is allergic to; it's the proteins in the animal's urine and saliva that stick to fur when the animal licks itself that makes you sneeze and wheeze.

8. It's possible to create an allergy-free home by ripping up the carpet and installing wooden floors.
False
This will certainly help, but completely ridding your home of dust mites may be impossible. They are so small you can't see them with the naked eye. And their population is determined by the humidity levels, the temperature, and the amount of fabric or upholstery in your home. Dust mites can literally live anywhere dust can accumulate.

Over-the-counter and prescription medicines

Although these drugs take the edge off, their effects are temporary and they offer no health benefits. They also present their own list of side effects.

• Antihistamines block the effects of histamine once it has been released. Depending on the drug, side effects can include dry nose, mouth, and throat, nausea and drowsiness, dizziness, blurred vision, insomnia, tremors, and irritability. It's important to note that a chronically dry mouth can increase risk of tooth decay and gum disease.3

• Corticosteroids (cortisone-like medicines) are used to provide relief for inflamed areas of the body. They lessen swelling, redness, itching, and allergic reactions. They are often used as part of the treatment for a number of different diseases, such as severe allergies or skin problems, asthma, or arthritis, and can be delivered topically for skin rashes, systemically for severe allergic rhinitis (hay fever), or inhaled for asthma. Corticosteroids are very strong medicines and should only be used for a very short time, as a last resort. They almost always produce side effects, many of which can be very serious.4

• Decongestants produce a narrowing of blood vessels, which helps clear nasal congestion. Ironically, many decongestants can cause a rebound effect that actually promotes the release of histamine release, leading the patient to feel even more congested than before. This drug can cause an increase in blood pressure in patients who have high blood pressure.5

• Immunotherapy involves getting a series of injections that are meant to desensitize you to specific allergens such as ragweed and pollen. It works but, obviously, only on those particular allergens you get the treatment for. Also, you should know, it is generally expensive and time consuming.6

What is Atopic Dermatitis?

Atopic dermatitis is a long term skin disease. “Atopic” refers to the tendency to develop allergy conditions. “Dermatitis” means swelling of the skin. In atopic dermatitis the skin rash is intensely itchy, inflamed, dry, red and scaly, and sometimes crusts and oozes; it can be widespread or limited to a few areas of the body.

Atopic dermatitis is found in people all over the world, and it affects about 10% of infants and 3% of the total population in the U.S. Approximately 60% of patients experience their first outbreak by age 1 and 90% by age 5. Onset of atopic dermatitis in adolescence or later is unusual.

In teens and young adults, the dry, scaly patches typically occur on the hands and feet. But it can affect any area, including inside of the elbows, backs of the knees, ankles, wrists, face, neck, and upper chest. The rash tends to crust and may ooze when it appears on the palms, backs of the hands, fingers, or on the feet. The skin can get infected if the patient scratches until it bleeds.

The exact cause of atopic dermatitis is unknown, but current theories focus on a disordered immune response, especially an imbalance of cytokines—proteins produced by white blood cells that act as chemical messengers between cells. They can stimulate or inhibit the growth and activity of various immune cells.10

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Escape the Misery of Allergies

Finally! New Herbal Extracts Provide Both Short Term and Long Term Control of Atopic Dermatitis, Asthma and Hay Fever

On average, adults get between two and five colds each year, and children get between six and ten. On top of that, more than 50 million Americans have allergies. So how can you tell whether your red, runny nose and watery eyes are the result of a virus or allergen?

Allergy Attack

Is it an allergy or a cold?

Sometimes it's not so easy to tell. Take these hypothetical cases, for instance. Tom, a 40-year-old businessman, wakes up with a scratchy throat. As the day progresses he starts sneezing, and by late afternoon his nose is dripping like a faucet. He wakes up feeling lousy, but he goes to work anyway and uses an entire box of tissues.

Over the next few days his symptoms dissipate, and in a week he feels a bit tired, but his congestion has disappeared. After a couple of weeks, Tom is completely back to normal.

It's springtime, and Allison, a 30-year-old teacher, is on a morning, outdoor field trip with her class. Her eyes itch, and her students are playfully keeping count of how many times she sneezes. (One student counts 21 sneezes in a row.) Allison returns to school mid-afternoon, and her symptoms ease up. But the next morning she wakes up sneezing, and continues to sneeze until early afternoon. This continues for about a week, and then her symptoms get worse. Her eyes, nose and throat itch and she sneezes throughout the day. Allison feels miserable and is irritable with her students. She takes an over-the-counter antihistamine and her symptoms ease up, but she drags herself through the day, and her mouth feels uncomfortably dry. Chronic sinusitis is the most commonly reported chronic disease, affecting 16.3 percent of people (nearly 32 million) in the United States in 1997.

Chronic sinusitis is the most commonly reported
chronic disease, affecting 16.3 percent of people
(nearly 32 million) in the United States in 1997.

You've probably guessed by now that Ted had a cold, and Allison has hay fever. Their cases are typical. Ted recovered quickly from his cold, but Allison, like most allergy sufferers, continued to get worse instead of better. The pharmaceutical drug she took only masked her symptoms, temporarily, and caused her mouth and nasal passages to dry out. It also made her feel lethargic.

There's a better way to deal with allergies

Supplements containing healthy phytochemicals and botanical extracts work to alleviate symptoms without negative side effects, and strengthen the system so it doesn't over react to allergens. On the other hand, pharmaceuticals and most "natural" antihistamines usually contain only inhibitors of histamine release. These may provide rapid relief but most likely do not treat the real cause of long term allergy problems … which is the immune system's excessive release of allergy inducing chemicals.

We live in an allergic world

The prevalence of hay fever has increased substantially over the past 15 years.1 Whether that's due to our exposure to more environmental toxins or lower immunity and poorer overall health is hard to tell. One thing we know for certain is that allergies make you miserable. And unless you live in a glass bubble that protects you from the hundreds of allergens we're bombarded with every day, you have a 50% chance of testing positive to one or more allergens (i.e. dust mite, rye, ragweed, or cockroach).2

What happens when you have an allergic reaction?

Normally your immune system protects your body from harmful substances such as bacteria, viruses, and toxins (or antigens, any substance that causes your immune system to produce antibodies). White blood cells produce an antibody specific to the antigen. This process is called sensitization.

But if you have an allergy, your immune system treats the substance—called an allergen—as a foreign body, and overreacts by producing antibodies called immunoglobulin E (IgE). These antibodies then cause mast cells to release chemicals and hormones called mediators—such as histamine—into your bloodstream to defend against the allergen invader. Mediators have effects on local tissue and organs, in addition to activating more white blood cell defenders.

When these chemicals are released they can irritate your eyes, nose, throat, lungs, skin, or gastrointestinal tract as your body tries to rid itself of the invading allergen. Future exposure to that same allergen (such as pollen or mold) will trigger this allergic response again, so that every time you're exposed to it, you have an "allergy attack."

Common hay fever and dermatitis symptoms

The release of histamine produces a number of symptoms which vary according to an individual's hypersensitivity, including:

sneezing
runny nose
watery, itchy eyes
swelling of the face and neck
itchy skin rashes
asthma

Almost anything can trigger an allergic reaction.

Here are some of the most common allergens and causes:

pollen (especially from weeds, trees, grasses)
molds
dust mites
animal dander
plants (poison ivy)
feathers (as in down comforters and pillows)
medications
certain foods
insect venom
viruses and bacteria (may cause an asthma attack or rash)
vaccines and medications
latex rubber
aspirin
extreme change in environmental temperature
emotional upset
hypersensitive skin
cockroaches, especially in inner cities (Exposure to cockroach-infested buildings may be a major cause of the high rates of asthma in inner-city children.)

Adrenal fatigue can result in allergies

Adrenal fatigue is any decrease in the ability of the adrenal glands to carry out their normal functions. The adrenals are no bigger than a walnut and sit on top of each kidney, in the back, near the bottom of the ribs on each side of your spine. They are the major steroid factories of the body producing or contributing to the production of about 150 vital hormones essential to your health and energy production.

What is adrenal fatigue?

When stress overextends the capacity of your body to compensate and recover, the adrenals become fatigued and are unable to continue responding adequately to further stress. Typically what happens to many people is that they get into a vicious cycle of relying on coffee, colas and other stimulants to keep them going throughout the day. Eventually they get a second wind and end up working very late into the night. It becomes harder and harder for them to get going in the morning, so they drink more caffeine, perpetuating the cycle.

But that's only the beginning. According to James L. Wilson, ND, DC, Ph.D., author of Adrenal Fatigue: The 21st Century Stress Syndrome, adrenal fatigue manifests as a collection of signs and symptoms, known as a 'syndrome.' Its chief symptom is fatigue, but once the adrenal buffer is gone, you become susceptible to a long list of health complaints including allergies, asthma, respiratory infections, chronic fatigue syndrome, fibromyalgia and other immune disorders. Making a few lifestyle changes, such as practicing a stress reduction technique, getting plenty of sleep and eating a well-balanced, nutritious diet, as well as taking Vitamins B-5 and C, ashwagandha—an ayurvedic herb especially useful in treating adrenal fatigue—licorice, Siberian ginseng, and adrenal gland extracts are all excellent ways to support healthy adrenal function.

Botanical extracts provide relief from atopic dermatitis, asthma and hay fever—safely and naturally, without side effects

Taken together in one nutritional supplement, these botanical extracts provide a synergistic effect to help control the common symptoms and causes of allergies by inhibiting histamine release and correcting immune system dysfunction.

And the outstanding benefit of taking them all together is that they provide short-term relief of symptoms and long-term allergy control by supporting healthy immune function.

Herbs	Atopic Dermatitis	Asthma	Hay Fever
Persimmon Leaf	X
Apple Extract	X
Pine Bark Extract	X	X
Luteolin	X	X	X
Rosemary Extract		X	X
Rhus Punjabensis Extract	X	X	X
Hesperidin			X

Natural relief for those who suffer from atopic dermatitis

• Persimmon leaf extract
Persimmon has been cultivated in Japan for at least 1,000 years, where it is considered the national fruit. So it only seems natural that Japanese researchers discovered that the main flavonoid in persimmon—astragalin—inhibits the release of histamine in mice suffering from atopic dermatitis. When the mice were given persimmon extract, they exhibited fewer behavioral symptoms, such as scratching and biting their skin. There was also a reduction of serum IgE, the antibodies produced in response to an allergen. Additionally, tissue samples showed there was less inflammation and thickening of the skin.7

More than 50 million Americans have allergies
and 20 million have asthma.

A second study performed by the same team found that the severity of the dermatitis was reduced dramatically in mice that were given the extract for four weeks. The preventive effect of persimmon leaf extract on the dermatitis was dose-dependent and continuous intake of persimmon leaf extract significantly decreased its onset and development. The scientists concluded that persimmon leaf extract may be an alternative remedy for managing atopic dermatitis.8

• Apple Extract
It's no wonder that apples were the chosen fruit in the Garden of Eden. They have numerous health benefits, and just recently researchers found that drinking apple juice supports brain health.

Apple extract also reduces allergy symptoms. Apples contain many kinds of polyphenols, and the main components are oligomeric proanthocyanidins. Apple extract was found to be especially beneficial in helping regulate allergic reactions. In double-blind clinical trials Apple extract ameliorated symptoms in children with atopic dermatitis, and also produced positive results in tests using allergic laboratory animals.9

• Pine Bark Extract
Pine bark extract, made from the bark of pine trees, contains a unique combination of proanthocyanidins, bioflavonoids and organic acids. Pine extracts and teas were commonly used by early Europeans and Native Americans.

Today, pine bark extract is considered a potent antioxidant and anti-inflammatory and is revered for its numerous health benefits, including relief from inflammatory skin conditions, such as atopic dermatitis and psoriasis.11-13

Botanical extracts alleviate asthma symptoms

Asthma is a chronic lung disease in which the airways become blocked or narrowed, making it difficult to breathe. This disease affects nearly 20 million Americans, and the numbers keep rising. Asthma is divided into two types: allergic (extrinsic) asthma and non-allergic (intrinsic) asthma.

In healthy people the airways to the lungs are fully open, allowing air to move in and out freely. But asthmatics have inflamed, super-sensitive airways. Allergic triggers cause the following airway changes, which in turn cause asthma symptoms:

The lining of the airways swell and become more inflamed
Mucus clogs the airways
Muscles tighten around the airways (bronchospasm)

As a result, the airways narrow, until breathing becomes difficult and stressful.

The following remedies have been shown to help alleviate allergic asthma:

• Pine Bark Extract
Pine bark extract inhibits the release of histamine from mast cells14, and may prove to be a key player in the relief of asthma symptoms.
Four to five million children under the age of 18 suffer from asthma in the United States. A 2004 clinical trial at the School of Medicine, Loma Linda University, CA, found that children and teens suffering from mild to moderate asthma had improved pulmonary functions after taking Pine bark extract for just one month.

The effectiveness of pine bark extract was based on four factors: the ability to breathe, the severity of asthma symptoms, frequency of rescue inhaler use, and the amount of inflammatory molecules in the child's body. The study showed that breathing improved after only one month of using the supplement, and that it continued to improve with further use.

The double blind and placebo-controlled study followed 60 children ranging from 6 to 18 years for three months. The children who took pine bark extract were able to reduce their need for rescue inhaler use and in some cases stop inhaler use altogether more often than the placebo group.15

Previous studies have shown pine bark extract to be effective in decreasing asthma symptoms among adults, without any adverse effects.16-17

• Luteolin
Luteolin is a flavonoid found in parsley, thyme, artichoke, basil, celery, and rosemary. It inhibits oxidative damage to cellular DNA, and suppresses excess levels of inflammatory cytokines such as interleukin-6 and interleukin-1B, which play a major role in allergic diseases.

Luteolin is commonly found in Chinese herbal asthma medicines. A study at the College of Medicine, Taipei Medical University, Taiwan, found that luteolin inhibited the release of histamine in laboratory animals, and relaxed the animals' tracheas.18

Two other studies on laboratory animals found that luteolin was an effective asthma19 and allergy preventative.20

• Rhus Punjabensis Extract
Rhus punjabensis extract is a source of anti-allergic flavonoids. Studies have shown that it suppresses excess levels of the inflammatory cytokines interleukin-4 and interleukin-1321, and interleukin-522, which play a major role in allergic diseases.

Take the sneezes out of hay fever (allergic rhinitis), without the side effects of antihistamines.

• Rosemary Extract
Rosemary extract is a source of rosmarinic acid which prevented inflammation of the airways in laboratory animals after they were exposed to house dust mites, leading researchers to suggest that it might be helpful to asthmatic patients.23

• Hesperidin
Hesperidin is the predominant flavonoid in lemons and oranges. Sweet oranges and tangelos are the richest dietary source of hesperidin, which is purported to relieve allergy and hay fever symptoms. Hesperidin is also found in rosemary leaves.24

Allergies costs us $3 billion per year
in lost time from work and school.

Conclusion

Although conventional drugs are effective for many hay fever and allergy sufferers, botanical extracts offer a safe and effective way of alleviating symptoms, while avoiding the unpleasant side effects of those drugs. And for asthmatics who must rely on inhalers, rhus punjabensis extract, luteolin, pine bark extract and rosemary extract all offer an opportunity to decrease use of corticosteroids, and/or complement their use.

Let's face it, allergies make you miserable. This time around, instead of relying on pharmaceuticals that provide temporary relief and add different symptoms to the mix, why not try these proven extracts? They have impressive studies to back them up, and because atopic dermatitis, asthma, and hay fever all result from an excess of inflammatory mediators, you can take any or all of them to relieve your hay fever, dermatitis and/or asthma.

Tips for Reducing Your Allergy Symptoms

Avoid contact with cats, dogs, birds and horses.

Take an excellent Vitamin C supplement.

Essential fatty acids—fish oil, or flaxseed oil—help promote healthy skin and are beneficial to those suffering from dermatitis.

Support your adrenal glands with a supplement containing licorice, Siberian ginseng, Vitamin C, Vitamin B-5, adrenal extract, and ashwagandha.

Take a nutritional supplement containing extracts of persimmon leaf extract, apple polyphenol extract, luteolin, hesperidin, rosemary leaf extract, pine bark extract, and rhus punjabensis extract.

Eat lots of brightly colored fruits and veggies, which are rich in vitamins, minerals, phytochemicals, and antioxidants.

Drink plenty of water in order to flush out toxins and stay hydrated.

Avoid sugar, white flour, and refined carbohydrates.

Keep windows and doors closed during your worst allergy seasons. Use an air filter to help remove pollen and dust from indoor air, but be sure to change the filter frequently.

Limit your outdoor activity in the early morning hours during allergy season to avoid exposure to high pollen concentrations.

Use hypoallergenic soaps, shampoos, cosmetics, and pillows.

The filter screens of air conditioners get filled up with dust and mold. Be sure to clean them at least every six weeks.

Dust mites live in bedding, upholstery, and carpets, so:

Remove rugs or carpeting, and go with wooden floors. If you must have carpeting, have it cleaned professionally at least once a year.

Keep your bedroom as dust-free as possible.

Replace down-filled pillows and comforters with hypoallergenic ones.

Encase your mattress and pillows with special dust-proof plastic or fabric covers. (Bedding covers made of 3M™ Propore™ fabric create an effective barrier against dust mites and allergens.)

Wash your sheets often and your bedspread every other month.

Vacuum frequently (consider purchasing a special air filter for your machine or an allergy-proof HEPA vacuum) and damp-mop after each vacuuming to remove lingering mold, mites, and pollen.

Replace any dust-trapping venetian blinds and pleated curtains with roll-down shades.

Install an air purifier.

References

Linneberg A et al. "The prevalence of skin-test-positive allergic rhinitis in Danish adults: two cross-sectional surveys 8 years apart. The Copenhagen Allergy Study." Allergy 55:767-772. 2000.
Arbes SJ et al. "Prevalences of positive skin test responses to 10 common allergens in the US population: Results from the Third National Health and Nutrition Examination Survey." Journal of Allergy and Clinical Immunology 116:377-383. 2005.
Abstract
MayoClinic.com, http://www.mayoclinic.com
/health/drug-information/DR202060
MayoClinic.com, http://www.mayoclinic.com
/health/drug-information/DR202018
MayoClinic.com, http://www.mayoclinic.com
/health/drug-information/DR202184
MayoClinic.com, http://www.mayoclinic.com
/health/allergy-shots/AA00017
Kotani M, Matsumoto M, Fujita A, Higa S, Wang W, Suemura M, Kishimoto T, Tanaka T. Persimmon leaf extract and astragalin inhibit development of dermatitis and IgE elevation in NC/Nga mice. J Allergy Clin Immunol. 2000 Jul;106(1 Pt 1):159-66.
Abstract
Matsumoto M, Kotani M, Fujita A, Higa S, Kishimoto T, Suemura M, Tanaka T. Oral administration of persimmon leaf extract ameliorates skin symptoms and transepidermal water loss in atopic dermatitis model mice, NC/Nga. Br J Dermatol. 2002 Feb;146(2):221-7.
Abstract
Akazome Y Characteristics and physiological functions of polyphenols from apples. Biofactors. 2004;22(1-4):311-4.
Abstract
American Academy of Allergy, Asthma and Immunology. http://www.aaaai.org
Rihn B, Saliou C, Bottin MC, Keith G, Packer L.
From ancient remedies to modern therapeutics: pine bark uses in skin disorders revisited. Phytother Res. 2001 Feb;15(1):76-8.
Abstract
Bito T, Roy S, Sen CK, Packer L. Pine bark extract pycnogenol downregulates IFN-gamma-induced adhesion of T cells to human keratinocytes by inhibiting inducible ICAM-1 expression. Free Radic Biol Med. 2000 Jan 15;28(2):219-27.
Abstract
Saliou C, Rimbach G, Moini H, McLaughlin L, Hosseini S, Lee J, Watson RR, Packer L. Solar ultraviolet-induced erythema in human skin and nuclear factor-kappa-B-dependent gene expression in keratinocytes are modulated by a French maritime pine bark extract. Free Radic Biol Med. 2001 Jan 15;30(2):154-60.
Abstract
Sharma SC, Sharma S, Gulati OP. Pycnogenol inhibits the release of histamine from mast cells. Phytother Res. 2003 Jan;17(1):66-9. Abstract
Lau BH, Riesen SK, Truong KP, Lau EW, Rohdewald P, Barreta RA. Pycnogenol as an adjunct in the management of childhood asthma. J Asthma. 2004;41(8):825-32.
Abstract
Hosseini S, Pishnamazi S, Sadrzadeh SM, Farid F, Farid R, Watson RR. Pycnogenol((R)) in the Management of Asthma. J Med Food. 2001 Winter;4(4):201-209.
Abstract
Rohdewald P. A review of the French maritime pine bark extract (Pycnogenol), a herbal medication with a diverse clinical pharmacology. Int J Clin Pharmacol Ther. 2002 Apr;40(4):158-68. Review.
Abstract
Ko WC, Shih CM, Leu IJ, Chen TT, Chang JP.
Mechanisms of relaxant action of luteolin in isolated guinea pig trachea. Planta Med. 2005 May;71(5):406-11.
Abstract
Das M, Ram A, Ghosh B. Luteolin alleviates bronchoconstriction and airway hyperreactivity in ovalbumin sensitized mice. Inflamm Res. 2003 Mar;52(3):101-6.
Abstract
Makino T, Furuta A, Fujii H, Nakagawa T, Wakushima H, Saito K, Kano Y. Effect of oral treatment of Perilla frutescens and its constituents on type-I allergy in mice. Biol Pharm Bull. 2001 Oct;24(10):1206-9.
Abstract
Hirano T, Higa S, Arimitsu J, Naka T, Shima Y, Ohshima S, Fujimoto M, Yamadori T, Kawase I, Tanaka T. Flavonoids such as luteolin, fisetin and apigenin are inhibitors of interleukin-4 and interleukin-13 production by activated human basophils. Int Arch Allergy Immunol. 2004 Jun;134(2):135-40. Epub 2004 May 17. Abstract
Higa S, Hirano T, Kotani M, Matsumoto M, Fujita A, Suemura M, Kawase I, Tanaka T. Fisetin, a flavonol, inhibits TH2-type cytokine production by activated human basophils. J Allergy Clin Immunol. 2003 Jun;111(6):1299-306.
Abstract
Inoue K, Takano H, Shiga A, Fujita Y, Makino H, Yanagisawa R, Ichinose T, Kato Y, Yamada T, Yoshikawa T. Effects of volatile constituents of a rosemary extract on allergic airway inflammation related to house dust mite allergen in mice. Int J Mol Med. 2005 Aug;16(2):315-9.
Abstract
Okamura N, Haraguchi H, Hashimoto K, Yagi A.
Flavonoids in Rosmarinus officinalis leaves. Phytochemistry. 1994 Nov;37(5):1463-6.
Abstract
Hanson LA, Korotkova M, Telemo E. Breast-feeding, infant formulas, and the immune system. Ann Allergy Asthma Immunol. 2003 Jun;90(6 Suppl 3):59-63.
Abstract

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