® Opiates (morphine, meperidine, codeine, hydrocodone, and others) stimulate mast cell release directly, resulting in pruritis and urticaria with occasional mild wheezing. Though these reactions are not allergic, many patients state that they are "allergic" to one or more of the opiates. Pretreatment with an antihistamine may reduce these reactions. These pseudoallergic reactions are rarely, if ever, life threatening.5 Avoiding other mast cell degranulating medications while patients require opiates also reduces the chances of frightening and uncomfortable reactions. Patients may state they are allergic if they have experienced gastrointestinal upset, a common side effect to opiates, with previous exposures. Obtaining a thorough history from the patient will prove useful. If a more serious reaction has occurred, a non-narcotic analgesic should be selected.

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