Codeine is an opioid medication often prescribed for mild to moderate pain relief and cough suppression. It acts on the central nervous system to reduce discomfort. A true, immune-mediated allergy to codeine is possible, but it is exceedingly rare. Objectives: The purpose of this study was to characterize the incidence of newly suspected IgE-mediated reactions (IMRs) based on clinical criteria among patients with a chart-documented opioid allergy and to assess clinician perceptions of opioid allergies. Very few people have true allergies to codeine. In fact, doctors say allergic reactions to opioids like codeine make up less than 2% of all hypersensitivity reactions in patients undergoing anesthesia. True anaphylactic reactions to opioids are very rare ( 1%). But what happens when you have a patient with a true allergy, but still need to give an opioid? No problem, you just need to choose one that is structurally different. Experts recommend using TraMADol ONLY for patients who have mild reactions to opioids. Group 1 (the naturally occurring agents –opiates) and group 2 (the semi-synthetic) are structurally very similar to each other and should be avoided if there is a true allergy to any of the group 1 and 2 members. The natural and semi-synthetics have cross-reactivity. Learn what to give if a patient is allergic to codeine, including non-opioid and alternative opioid options, and how to differentiate a true allergy from a pseudoallergy. Codeine allergies are extremely rare, but codeine can cause a histamine reaction with allergy-like symptoms. Pseudoallergies with codeine have symptoms like hives and itching, while true codeine allergies can cause life-threatening complications like anaphylaxis. For patients with a codeine allergy, non-steroidal anti-inflammatory drugs (NSAIDs) are recommended as first-line alternatives for mild to moderate pain, while hydromorphone, morphine, or fentanyl are recommended for moderate to severe pain. 1 Learn about what a codeine allergy is, and how to recognize true allergic reactions. Expert guidance on treatment options and safe alternatives.