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The lack of immunogenicity has practical implications: the peptide can be used for extended periods without loss of efficacy due to antibody neutralization, there is minimal risk of allergic or hypersensitivity reactions, and repeated treatment cycles are supported as prior exposure does not sensitize the immune system

Meanwhile, as noted above, targeted neurological effects may best be achieved with nasal sprays

Patients can use an inexpensive refrigerator thermometer to monitor temperature and ensure compliance with storage requirements

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They can range from mild skin irritation to more serious symptoms

For these patients, oral B12 supplementation (1,000-2,000 mcg daily sublingual methylcobalamin) provides comparable B12 repletion without injection