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Many people dont consume enough Vitamin B12 in their diet and therefore experience a vitamin B12 deficiency, those who follow a vegetarian and vegan diet for example

Topical creams can be used instead of injections, if preferred

Repeatedly using the same injection site can lead to skin irritation, tissue damage, and even scar formation

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NNMT plays a key role in regulating cellular metabolism, NAD availability, and methylation pathways

So if you took B12 and felt worse, and your blood B12 is elevated, and you have a constellation of symptoms across multiple systems that's three signals pointing toward MCAS as worth ruling out