The orphan MAS-related G protein-coupled receptor member X2 (MRGPRX2) is expressed primarily in human dorsal root ganglia and mast cells, and has been suggested to modulate pain and itch. Using a high-throughput screen of 5,695 unique compounds, Lansu et al. discovered that many exogenous and endogenous opioids are agonists of MRGPRX2. Subsequent in silico structure-based modelling and docking identified the potent and highly selective MRGPRX2 probe ZINC-3573. The MRGPRX2-activating opioids and ZINC-3573 induced intracellular Ca2+ release and degranulation in a human mast cell line.