Skip to main content
SpringerLink
Log in

Intranasal treatment of vitamin B12 deficiency in children

  • Short Communication
  • Published:
European Journal of Pediatrics Aims and scope Submit manuscript

Abstract

Vitamin B12 deficiency is traditionally treated with intramuscular injections of cobalamin, which are stressful events for children. In adults, studies have shown adequate absorption of intranasally administered vitamin B12. To date, data concerning efficacy of intranasal administration of vitamin B12 in children are lacking. We report on ten cases of children with vitamin B12 deficiency who were successfully treated with intranasal administration of a spray containing hydroxocobalamin. The mean baseline vitamin B12 concentration increased from 126.3 pmol/l (SD 55.4) to 1914.7 pmol/l (SD 1509.7). No side effects were reported.

Conclusion: In children, intranasal application of vitamin B12 seems a safe and effective alternative to intramuscular injections, leading to higher compliance and less burden to patients.

What is Known:

• Children with vitamin B12deficiency are traditionally treated with intramuscular cobalamin injections, which are costly and painful.

• Studies in adults showed that intranasal application of hydroxocobalamin leads to normalisation of vitamin B12levels.

What is New:

• The intranasal application of vitamin B12resulted in a substantial increase of the mean baseline vitamin B12levels without any side effect.

• These data encourage a systematic evaluation of intranasal treatment of vitamin B12deficiency in order to define safety, optimal dosage and administration frequency.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abbreviations

MMA:

Methylmalonic acid

References

  1. Bensky MJ, Ayalon-Dangur I, Ayalon-Dangur R, Naamany E, Gafter-Gvili A, Koren G, Shiber S (2019) Comparison of sublingual vs. intramuscular administration of vitamin B12 for the treatment of patients with vitamin B12 deficiency. Drug Deliv Transl Res 9:625–630. https://doi.org/10.1007/s13346-018-00613

    Article  CAS  PubMed  Google Scholar 

  2. Benson J, Phillips C, Kay M, Webber MT, Ratcliff AJ, Correa-Velez I, Lorimer MF (2013) Low vitamin B12 levels among newly-arrived refugees from Bhutan, Iran and Afghanistan: a multicentre Australian study. PLoS One 8:e57998. https://doi.org/10.1371/journal.pone.0057998

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Blom HJ, van Rooij A, Hogeveen M (2007) A simple high-throughput method for the determination of plasma methylmalonic acid by liquid chromatography-tandem mass spectrometry. Clin Chem Lab Med 45:645–650. https://doi.org/10.1515/CCLM.2007.117

    Article  CAS  PubMed  Google Scholar 

  4. Cuevas-Nasu L, Mundo-Rosas V, Shamah-Levy T, Méndez-Gómez Humaran I, Avila-Arcos MA, Rebollar-Campos Mdel R, Villalpando S (2012) Prevalence of folate and vitamin B12 deficiency in Mexican children aged 1 to 6 years in a population-based survey. Salud Publica Mex 54:116–124

    Article  Google Scholar 

  5. Miller JL, Capino AC, Thomas A, Couloures K, Johnson PN (2018) Sedation and analgesia using medications delivered via the extravascular route in children undergoing laceration repair. J Pediatr Pharmacol Ther 23:72–83. https://doi.org/10.5863/1551-6776-23.2.72

    Article  PubMed  PubMed Central  Google Scholar 

  6. Pawlak R, Lester SE, Babatunde T (2014) The prevalence of cobalamin deficiency among vegetarians assessed by serum vitamin B12: a review of literature. Eur J Clin Nutr 68:541–548. https://doi.org/10.1038/ejcn.2014.46

    Article  CAS  PubMed  Google Scholar 

  7. Slot WB, Merkus FW, Van Deventer SJ, Tytgat GN (1997) Normalization of plasma vitamin B12 concentration by intranasal hydroxocobalamin in vitamin B12-deficient patients. Gastroenterology 113:430–433. https://doi.org/10.1053/gast.1997.v113.pm9247460

    Article  CAS  PubMed  Google Scholar 

  8. Stabler SP (2013) Clinical practice. Vitamin B12 deficiency. N Engl J Med 368:149–160. https://doi.org/10.1056/NEJMcp1113996

    Article  CAS  PubMed  Google Scholar 

  9. Tillemans MP, Donders EM, Verweij SL, Van der Hoeven RT, Kalisvaart KJ (2014) Effect of administration route on the pharmacokinetics of cobalamin in elderly patients: a randomized controlled trial. Curr Ther Res Clin Exp 76:21–25. https://doi.org/10.1016/j.curtheres.2014.01.001

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. U.S. National Library of Medicine. TOXNET Toxicology Data Network. Hydroxocobalamin. https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/f?./temp/~rpdPVM:3. Accessed 26 Oct 2019

  11. Wang H, Li L, Qin LL, Song Y, Vidal-Alaball J, Liu TH (2018) Oral vitamin B12 versus intramuscular vitamin B12 for vitamin B12 deficiency. Cochrane Database Syst Rev 3:CD004655. https://doi.org/10.1002/14651858.CD004655.pub3

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Paediatrics, St. Antonius Hospital, PB 2500, 3430 EM, Nieuwegein, The Netherlands

    G. Frederiek Estourgie-van Burk

  2. Department of Clinical Pharmacy, Erasmus Medical Centre, Rotterdam, The Netherlands

    P. Hugo M. van der Kuy

  3. Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location VU Medical Centre, Amsterdam, The Netherlands

    Tim G. de Meij & C. M. Frank Kneepkens

  4. Department of Paediatric Gastroenterology and Nutrition, Amsterdam University Medical Centres, Location Academic Medical Centre/Emma Children’s Hospital, Amsterdam, The Netherlands

    Marc A. Benninga

Authors
  1. G. Frederiek Estourgie-van Burk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Hugo M. van der Kuy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tim G. de Meij
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc A. Benninga
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. M. Frank Kneepkens
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study conception and design. Acquisition of the data was performed by FE, TdM, MB and FK. FE, HvdK and FK were involved in data interpretation. The first draft of the manuscript was written by FE. FE and FK wrote the manuscript. All authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to G. Frederiek Estourgie-van Burk.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Informed consent

Informed consent was obtained from all participants.

Additional information

Communicated by Mario Bianchetti

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Estourgie-van Burk, G.F., van der Kuy, P.H.M., de Meij, T.G. et al. Intranasal treatment of vitamin B12 deficiency in children. Eur J Pediatr 179, 349–352 (2020). https://doi.org/10.1007/s00431-019-03519-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00431-019-03519-0

Keywords

Search

Navigation