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Given the negative challenge test result with shrimp, we recommended the patient to avoid barnacles only.It is important to highlight that recommendations regarding food avoidance should be tailored.The reaction occurs mostly in patients who have already taken several intramuscular drugs. Desensitization is mandatory in patients who are allergic to this vitamin and with a clinical indication for vitamin B therapy.There are few protocols in the literature for desensitization to cyanocobalamin, most protocols have been designed with slow schemes lasting up to days, until a cumulative dose of g is reached.Two hours after the last administration of cyanocobalamin, the patient developed angioedema of the face and hands with generalized pruritus and urticaria, which remitted after oral intake of levocetirizine. He reported never having previously experienced an adverse reaction during treatment.Skinpricktestswithbothcyanocobalamin and cobam amidewereneg ativewithnondilutedsolution. Intradermal tests were subsequently performed with both cyanocobalamin and cobamam ide, start ing atadi lutionof: and progressing fold. On the same day, after reading intradermal testswith cyanocoba lam in, we perfo rmed intrade rmal tests with cobamamide, which yielded <a href="http://www.targetmol.com/compound/D-Cycloserine">Targetmol's D-Cycloserine</a> positive results at a concentration of: with erythema and pruritus accompanied by facial erythema and periorbital ang ioedema thatpromptly rever ted af ter oralin take of ebastine. After obtaining the patients written informed consent, we scheduled a desensitization protocol in order to reach a mg administration of vitamin B on a single day.Adverse reactions to vitamin B injections due to benzyl alcohol sensitivity: successful treatment with intranasal cyanocobalamin.Three solutions with different concentrations were administered subcutaneously every minutes, except for the last doses, which were separated by an interval of minutes.A total of subcutaneous injections were administered, with a total cumulative dose of g.Consistent with other authors, we selected the subcutaneous route because it is less painful than the intramuscular route.No local or systemic adverse reactions were observed, and the patient was discharged hours after the last injection.The medical team contacted the patient within hours.Complete blood coun ts and serumvi tam in B leve ls were normal.The patients vitamin B level increased from ngL before desensitization to ngL after desensitization.Vitamin B is an organic complex that is included in a family of compounds called cobalamins, which contain central   cobalt ions in a corrin ring.Cobalamins consist of major forms, namely, cyanocobalamin, cobamamide, hyd roxycoba lam in, and methylcobalamin.There are reports of patients who react to one form of cobalamin but tolerate an alternative formulation. Howeve r, seve ralreportshave shown sensitization to all injectable formulas of vitamin B and in vitro crossreactivity between all cobalamins. Considering these data and the possibility of crossreactions, we opted for cyanocobalamin, which showed less skin test reactivity, and performed a rapid desensitization protocol, which proved to be very successful.We report a cyanocobalamin rush desensitization protocol that made it possible to reach a cumulative dose of mg.The protocol enabled maintenance of an indispensable and very effective treatment.In addition, it was safe, costeffective, and very short.Anaphylactic reaction to hydroxycobalamin.Hipersensibilidade Vitamina B A possibilidade de dessensibilizao. You are solely responsible for determining the ownership of the copyright, and for obtaining permission for your intended use.

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