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People with a history of sensitivity or allergic reactions to Vitamin B12 should be closely monitored during treatment, and if signs of an allergic reaction occur (e.g., rash, itching, difficulty breathing), the injection should be stopped immediately

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Prescribers should also be aware that the American Academy of Pediatrics policy statement on off-label prescribing recommends that clinicians "use the best available evidence, inform families clearly about the off-label nature of the treatment, and document the clinical rationale thoroughly" [14]