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During unusual circumstances, such as the COVID-19 pandemic, the approach to managing chronic conditions like pernicious anaemia, which requires regular B12 injections, had to be adapted, potentially influencing the perception of efficacy and safety of the treatment among patients

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Mast cells can also induce elastin production through the cytokines (Hernndez-Barrera et al., 2008) which can lead to the activation of mast cell metalloproteinase (MMP) that in turn induce the degradation of collagen type 4 and damage basement membrane (Iddamalgoda et al., 2008)

However, due to rare but serious adverse effects (e.g., thrombocytopenia, cardiac arrhythmias, hypersensitivity reactions), many guidelines recommend against routine use