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The typical regimen involves: Loading dose for patients without neurological involvement : Hydroxocobalamin 1mg intramuscularly three times weekly for two weeks [13] [10] Loading dose for patients with neurological involvement : Hydroxocobalamin 1mg on alternate days until no further improvement, then Maintenance therapy : 1mg every two to three months (or every two months if neurological involvement) Lifelong maintenance therapy is necessary for irreversible causes such as pernicious anaemia or following gastric surgery

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H 1 and H 2 antihistamines, often following protocols for mast cell activation syndrome and particularly involving famotidine, are used to alleviate a wide range of symptoms 19,157 , although they are not a cure