Every time I look at my death recap, at least 33% of the damage was true damage from "items and runes." Everyone that hit me did at least 50 true damage. It shouldn't even be called true "damage" because "damage" reduction effects (like exhaust) do absolutely nothing to it. I like to call it "true f-you" because it really does just f-you. Can't build resistance, can't build enough hp, can't reduce its damage in any way, so it's not really damage. It's just f-you.