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Diagnosis typically includes testing for anti-intrinsic factor antibodies (and sometimes anti-parietal cell antibodies)

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doi: 10.1007/s11010-013-1689-4 111 AssefaBMahmoudAMPfeifferAFHBirkenfeldALSprangerJArafatAM

staggered scheduling and gradual dose escalation are recommended

Summary: Excessive vitamin B12 intake rarely causes toxicity, but very high levels from supplements or injections may be associated with skin reactions such as acne-like eruptions, though serious adverse effects remain exceptionally uncommon

Segraves RT, Lee J, Stevenson R, et al