Coeliac Disease: How to Check a Product, a Label and a Medicine

Reviewed July 22, 2026 by Sara, licensed pharmacist. This article is general education, not personal medical advice.

Editorial correction: the label comparison now distinguishes the legal meaning of “very low gluten” from individual dietary advice. The medicine section also clarifies that wheat starch does not automatically make a medicine unsuitable for coeliac disease.

Coeliac disease is not a food preference and it is not managed by “eating less bread”. It is an immune reaction to gluten that damages the small intestine, and the treatment — the only treatment — is a strict, lifelong gluten-free diet.

The general explanations of it are everywhere. What is harder to find is the practical layer: what the labels legally mean, how to check a medicine, and what the Italian system actually gives you. That is what this article is for.

First, the one thing that ruins a diagnosis

Do not stop eating gluten before you are tested.

Both the antibody blood tests and the intestinal biopsy detect the reaction that gluten is currently causing. Take gluten out first and both can come back negative in someone who genuinely has coeliac disease — and the only way out of that is a gluten challenge: weeks of deliberately eating gluten again while feeling unwell, and then repeating the tests.

If you suspect coeliac disease, discuss testing before changing your diet. This applies to children too. If you have already removed gluten, ask your clinician how to proceed rather than starting a gluten challenge on your own.

The same logic applies to a first-degree relative of someone diagnosed: coeliac disease runs in families, screening is straightforward, and it is worth asking for rather than pre-emptively changing what you eat.

What the label legally means

This is where most day-to-day mistakes happen, because three different things sound similar.

What it says	What it means	How to use the information
Senza glutine / gluten-free	Regulated claim: no more than 20 mg/kg (20 ppm) of gluten	The gluten-free threshold applies to the food as sold.
Con contenuto di glutine molto basso / very low gluten	A separate category up to 100 mg/kg, for specified ingredients specially processed to reduce gluten	Not equivalent to gluten-free. Discuss its place in your diet with the clinician or dietitian managing your coeliac disease.
”Naturalmente privo di glutine”	Describes a naturally gluten-free food; a gluten-free claim must still meet the legal threshold	Consider the finished product and preparation, as well as its ingredients.
”Può contenere tracce di glutine”	A precautionary statement about possible unintended presence; it does not give a measured gluten level	If suitability is unclear, check with the manufacturer or your dietitian rather than guessing from the wording.

EU Regulation 828/2014 defines both categories. Article 3 also permits the wording “suitable for coeliacs” alongside either compliant category. It is therefore incorrect to say that “very low gluten” legally means unsuitable for everyone with coeliac disease. The two thresholds remain different; the legal wording does not replace the dietary advice you have been given. A gluten-free claim is about a limit in the finished food, not a promise of absolute zero gluten.

In Italy there are two further shortcuts worth knowing:

The crossed grain symbol (spiga barrata), licensed through the Associazione Italiana Celiachia, indicates a product checked under that scheme rather than only self-declared.
The AIC Prontuario degli Alimenti, updated annually and available as an app, lists products assessed as suitable — including things you would never think to question, like some cured meats, stock cubes and flavoured crisps.

And an entitlement people frequently do not claim: a confirmed coeliac diagnosis in Italy gives access to a monthly SSN allowance towards gluten-free staple foods, arranged through the local ASL. The amounts differ by age, sex and region, and it is worth asking about at diagnosis rather than a year later.

How to check a medicine

Wheat starch appears as an excipient in some medicines. Its presence is a reason to read the product information, not automatically a reason to avoid the medicine. EMA explains that the small gluten amounts in these medicines are very unlikely to cause problems in coeliac disease; wheat allergy is a different condition and needs separate consideration.

The check, in order:

Open the foglio illustrativo and go to the section headed “Elenco degli eccipienti” — not the active ingredient line. You are looking for amido di frumento (wheat starch).
Read the accompanying information about gluten content and wheat allergy. Do not treat the word “wheat” as proof that the medicine is unsuitable for coeliac disease, or apply food labelling thresholds without considering the amount in a medicine dose.
If the leaflet is missing or unclear, ask the pharmacy to look up the product’s summary of product characteristics on the AIFA medicines database. Keep taking prescribed treatment unless the clinician or pharmacist advises a change.
Check a changed formulation. Different manufacturers can use different excipients. If a substitution raises a question, ask about the exact product supplied rather than assuming all brands have the same excipients.

The same applies to food supplements, herbal products and — often forgotten — flavoured or effervescent formulations, where more excipients are involved.

Where real life gets difficult

Avoiding gluten includes limiting cross-contact during preparation. Symptoms are not a reliable way to judge exposure: someone can have intestinal damage without obvious symptoms. Ask your dietitian for practical household precautions rather than interpreting the gluten-free threshold as permission to deliberately add gluten.

The contamination points that actually cause problems:

The toaster. The single most common one in a mixed household. A gluten-free household needs a dedicated toaster or toaster bags — crumbs cannot be cleaned out.
The colander, wooden spoons and wooden chopping boards, which hold residue in the grain.
Shared frying oil. Chips fried in the same oil as breaded food are not gluten-free.
Butter, jam and spreads that have had a bread knife in them. Separate jars, or squeeze bottles.
Flour in the air. In a kitchen where wheat flour is being worked, airborne flour settles for hours. Gluten-free cooking goes first, or in a different session.
Oats. Usually contaminated during growing and milling. Only certified gluten-free oats, and even then a minority of people react to the oats themselves — introduce them with advice.
Eating out. The useful question is not “do you have gluten-free options” but “how do you keep it separate” — dedicated pan, fresh water for pasta, separate surface. In Italy, the AIC’s list of trained restaurants is a shortcut worth using.

The pharmacist’s role in this

Realistically, three things:

Checking excipients on every new product and every generic switch, including OTC medicines you buy yourself.
Watching for the deficiencies that follow the damage: iron, folate, vitamin B12, vitamin D and calcium are the usual ones, and they are why persistent tiredness after diagnosis is worth investigating rather than accepting. Do not self-supplement into that gap — get the levels checked, then correct what is actually low.
Flagging when the diet is being followed and things are still not right, which is a reason to go back to the gastroenterologist rather than to try harder at home.

When to seek advice

Ask for medical assessment for persistent diarrhoea or abdominal pain, unexplained weight loss, ongoing tiredness or anaemia, recurrent mouth ulcers, or a child not growing as expected — before removing gluten.

After diagnosis, go back if symptoms return despite a strict diet, if new symptoms appear, or if blood results are not improving on follow-up. Coeliac disease is well managed but it is a lifelong condition with follow-up attached, not a diet you are handed once at the door.

Frequently asked questions

What does gluten-free actually mean on a label?

In the EU, a product may only be labelled gluten-free if it contains no more than 20 mg of gluten per kilogram (20 ppm). Very low gluten is a separate, less strict category up to 100 ppm, and it is not the same thing.

Can medicines contain gluten?

It is rare, but wheat starch is used as an excipient in some products. Look at the excipients section of the leaflet for amido di frumento, and ask the pharmacy to check the summary of product characteristics if you are unsure.

Why must I not remove gluten before being tested?

The blood tests and the biopsy both look for the reaction gluten causes. Remove it first and the tests can come back negative in someone who does have coeliac disease, which means starting the whole process again.

Is oat porridge safe with coeliac disease?

Oats are usually contaminated with wheat during growing and milling, so only oats specifically labelled gluten-free should be considered — and a minority of people react to oats themselves. Introduce them with advice, not on your own.