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Douglas C. Heimburger, MD, MS
University of Alabama at Birmingham

JAMA. 1991;265(17):2190.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

To the Editor.—

The Commentary by Dr Lederle¹ and the accompanying editorial of Drs Hathcock and Troendle² provide a straightforward and compelling argument for the use of oral cobalamin for the treatment of pernicious anemia whenever possible. In my experience, the vicissitudes and costs of monthly intramuscular cobalamin injections often result in discontinuation of the therapy entirely, putting patients at risk for recurrent deficiency. Oral therapy should ameliorate this problem.

However, there may be another alternative that the authors did not describe, and of which few physicians are aware: nasal cobalamin. For a number of years, an intranasal cyanocobalamin gel called Ener-B has been available over the counter. It is sold in packages of 12 unit-dose tubes, each containing 400 µg of cyanocobalamin. The manufacturer (Nature's Bounty, 90 Orville Dr, Bohemia, NY 11716) has targeted the product at the health-foods market and has not promoted it among physicians . . . [Full Text PDF of this Article]

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