Anaphylaxis – Adrenaline (Epipen), Prednisolone, Hydrocortisone

Medical information to support a TUE application – Anaphylaxis – Adrenaline (Epipen), Prednisolone, Hydrocortisone

Anaphylaxis is a serious allergic reaction that can be rapid in onset and in very rare cases result in death. Anaphylaxis is commonly caused by triggers such as nuts, shellfish, stinging insects and some medications. In some cases no trigger can be identified.


Status of medication in sport


Adrenaline is prohibited in-competition and requires a Therapeutic Use Exemption (TUE). It is usually given as an injection for the management of anaphylaxis. Usually only one or two doses are required.


Systemic treatment with glucocorticoids (e.g. Prednisolone, Methylprednisolone or Hydrocortisone) is prohibited in-competition and requires a TUE. It may be given orally or by injection, but both require a TUE if taken during or just before competition.


What information is required for a TUE application?

  • A completed TUE application form signed by the treating doctor and athlete.
  • Detailed typed clinical letter(s) from treating specialist(s) that includes:
    • diagnosis – summary of clinical history and examination leading to diagnosis. This will often include sudden onset of characteristic symptoms and signs, usually within minutes to hours of exposure to the trigger (this may be a letter from the emergency department to the GP, or a specialist’s report)
    • consideration of differential diagnosis
    • response to alternative medications (if appropriate) not prohibited by the World Anti-Doping Agency
    • management to date, including number of episodes of anaphylaxis, dose of adrenaline required and clinical response, and
    • anaphylaxis management plan (if available).

NOTE: A clinical letter can be a copy of a specialist’s letter to another doctor (e.g. a GP), and at least one of the clinical letters submitted with the application must have been written in the last 12 months.

  • Supplementary reports (if available) that support the diagnosis, including blood test results (tryptase levels if available) and skin prick test results.


For additional information please refer to the medical information relating to the condition on the WADA website.