Apply a generous, even layer of Step 1 from base to tip
B12 shot benefits include increased energy, support for healthy nervous system function, and a boost in red blood cell formation
As PA is an auto-immune condition it may be helpful to rule out auto-immune thyroid with the correct testing - which is very rarely done in the NHS
Particularly for those on topical steroids, abrupt cessation can trigger severe rebound flares that make peptide assessment impossible
as for patients with neurological improvement, 1 mg IM OH-Cbl on alternate days until there is no clinical improvement and then maintenance 1 mg IM OH-Cbl every 2 months is recommended ( g low-dose daily oral CN-Cbl is licensed ( In Canada, advice from the British Columbia Medical Association outlines that 1 mg daily oral CN-Cbl should be used for pernicious anemia or food-bound cobalamin malabsorption (FBCM) whereas in most other cases, a daily dose of 250 g may be used ( In Netherlands, controversy arose when the Dutch Organization of General Practitioners published a 2014 viewpoint that 1 mg daily oral OH-Cbl can be utilised as treatment in cases with a cobalamin count below 148 pmol/L and clinical symptoms, with the Dutch B12 Society disputing the efficacy of this and insisting that the advice from the Dutch Healthcare Institute Pharmacotherapeutic Compass should be followed instead (IM/SC starting dose of 10 injections of 1 mg OH-Cbl at intervals of at least 3 days
