Cohen Engler, A., Hadash, A., Shehadeh, N., & Pillar, G
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Cyanocobalamin has to go through a complex conversion process within the body in order to become active and many people cannot do these conversions well, so often much of the dose goes unused (even with a shot)
Lastly, type 3 and type 4 hypersensitivity results in the formation of antigenantibody immune complexes or a delayed T cell-mediated reaction, respectively, either of which may progress to the life-threatening Stevens-Johnson syndrome or toxic epidermal necrolysis [4, 5]
Giugliano et al