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Tetramerization forces the N-terminal threading arms from the arm-exchanged dimer to cover the heme active site for the other pair of dimers and suggests that catalase fits the more general pattern of domain swapping with the arm-exchange being a later, tetramer-dependent elaboration

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For example, additives such as carboxymethyl cellulose and mannitol can cause acute reactions

How long it lasts can be anywhere from a few minutes to hours, based on the dose and how well the patient can handle it