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From an immunological perspective, these associations arise from a breakdown in self-tolerance mediated by overlapping T-cell and B-cell autoreactivity, shared cytokine pathways (e.g., IFN-, IL-18), and common antigen-presenting HLA alleles

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Regulatory guidance from the Food & Drug Administration (FDA) and WHO emphasizes that proper aseptic technique, storage procedures, environmental controls, and documentation practices remain essential regardless of the presence of preservatives