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The importance of environmental factors in the pathogenesis of autoinflammatory and autoimmune diseases is widely acknowledged

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Tobacco-specific nitrosamines (C10H 13 N 3 O 2 and C 9 H 11 N 3 O): These chemicals form when tobacco leaves are cured, aged, and processed

Diagnostic Considerations The best way to establish the diagnosis is to ask the patient and the parents about their own tobacco and nicotine product use

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