BOMRA has reviewed literature that associate pholcodine and perioperative anaphylaxis Data from a multicenter case-control study (ALPHO) comparing pholcodine exposure within a year before anesthesia between patients with NMBA-related POA (cases) and control patients with uneventful aesthesia was reviewed. The ALPHO has confirmed a significant association between pholcodine consumption in the year preceding NMBA exposure and NMBA-related POA (OR adjusted 4.2 CI 95% [2.5; 6.9]). Other environmental factors, including occupational exposure to quaternary ammonium, should be considered in the risk of NMBA-related anaphylaxis, but they currently remain poorly defined. The European Commission issued a legally binding decision applicable in all EU Member States to withdraw pholcodine containing products in March 2023. Subsequent to this a number of National Regulatory Authorities have removed Pholcodine from their markets and these include United Kingdom, Australia, Malaysia and South Africa.