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. 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 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. 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. 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. Experts recommend using TraMADol ONLY for patients who have mild reactions to opioids. 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. 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. 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. Learn about what a codeine allergy is, and how to recognize true allergic reactions. Expert guidance on treatment options and safe alternatives.