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The MHRA and EMA have not identified histamine intolerance as a recognised adverse effect, though gastrointestinal symptoms from both conditions may overlap

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When each is the better choice Choose a pen if you inject daily or more frequently, if your doses are small and precision matters most, if needle anxiety is an issue, if you value convenience and portability, or if you are committed to a long-term protocol where consistency determines outcomes

Assumptions regarding the current management, including follow-up of B12 deficiency in the general community, may also need to be challenged