Gluten-Free Products - Adult and Paediatric

General Notes
  • Gluten-free foods should only be prescribed on NHS prescriptions for patients with established gluten-sensitive enteropathies, coeliac disease and dermatitis herpetiformis.

  • In adults diagnosis must be made by positive antibody blood test and/or gut biopsy.  Initial diagnosis and management should involve a gastroenterologist and a dietitian.

  • In paediatrics diagnosis and management must be made by a consultant paediatric gastroenterologist and a paediatric dietitian. Guidance on the current and new ESPGHAN diagnosis and management of coeliac disease can be found on the paediatric gastroenterology pages on Refhelp: http://www.refhelp.scot.nhs.uk.
    If there are any questions please contact Dr Peter Gillett (Consultant Paediatric Gastroenterologist) and/or the Specialist PGHAN dietitians at RHSC.
  • Prescriptions for gluten-free foods should not be issued until diagnosis has been confirmed (even a short period of gluten avoidance will mask the diagnosis).
  • Guidance on the management and referral in primary care can be found on the Refhelp website

  • Only those foods listed by the Advisory Committee on Borderline Substances (ACBS) should be prescribed.

  • The Scottish Government Gluten-Free Food (GFF) Pharmaceutical Service allows patients to self-manage their gluten-free prescriptions with the assistance of community pharmacy. Further information can be found at www.nhslothian.scot.nhs.uk/Services/A-Z/GlutenFreeFoodService/Pages/default.aspx.
Quantities to prescribe
  • The quantity of gluten-free foods a patient requires is based on recommended nutritional intake for a health balanced diet, following these key principles
    • total carbohydrate intake should provide 50% of a patients total energy requirement.  This should come from potatoes and rice, as well as gluten-free products
    • gluten-free foods should provide 15% of a patients total energy requirements
  • Coeliac UK (www.coeliac.org.uk) provide guidance on the number of units that may be required by a patient. This may need to be increased for adults with particularly active lifestyles or occupations; or for children and young people with particularly active lifestyles or those who require additional nutrition for growth. Exceptions to these amounts should be on advice of a dietitian.

  • Gluten-free foods that are not normally required are biscuits, cakes and cake mixes. However exemptions may be made for those children and young people with growth concerns - if so, this will be advised in writing by specific recommendation of a paediatric dietitian.





    Age

    Number of units

    child 1 - 3 years

    child 4 - 6 years

    child 7 - 10 years

    child 11 - 14 years

    child 15 - 18 years


    male 19 - 59 years

    male 60 - 74 years

    male ≥75

    female 19 - 74 years

    female ≥75

    female breastfeeding

    female in 3rd trimester of pregnancy

    high physical activity level

    10

    11

    13

    15

    18


    18

    16

    14

    14

    12

    add 4

    add 1

    add 4

Fresh bread
First Choice:
Warburtons can only be ordered in multiples of 4
Second Choice:
Juvela can only be ordered in multiples of 8*
orGlutafin Select can only be ordered in multiples of 8
Long-life Bread
First Choice:
Glutafin
Second Choice:
Juvela
Fresh Rolls
First Choice:
Warburtons can only be ordered in multiples of 4 packs
Second Choice:
Juvela fresh (can only be ordered in multiples of 8* packs)
orJust can only be ordered in multiples of 6 packs
Long-life Rolls
First Choice:
Glutafin part-baked  
Bread mix
First Choice:
Glutafin Select
Flour
First Choice:
Glutafin Select multipurpose
Second Choice:
Juvela
Pasta
First Choice:
Juvela
Second Choice:
Glutafin
orBarkat Animal Pasta (may be suitable for children to encourage compliance to a gluten-free diet.) Delivery costs are incurred with this product.
Crackers/crispbread
First Choice:
Glutafin crispbread
orGlutafin mini crackers
orWarburtons bran crackers
Pizza base
First Choice:
Juvela pizza base
Second Choice:
Glutafin gluten-free pizza base
Breakfast cereal
First Choice:
Food first principles - see note on supermarket own brand cereal
Second Choice:
Juvela Fibre Flakes
Nairns Gluten-free Oat Porridge
Formulations/Dose
  • Warburtons gluten and wheat-free white/brown bread (4x400g)
  • Juvela fresh fibre bread-sliced or fresh white bread-sliced (8x400g)* can be ordered in combination with fresh rolls, 4 packs of each.
  • Glutafin Select fresh brown loaf or fresh white loaf or fresh seeded loaf (8x400g)
  • Glutafin gluten-free sliced fibre loaf or white loaf (300g)
  • Juvela gluten-free fibre loaf sliced or white loaf sliced (400g)
  • Warburtons gluten and wheat-free white or brown rolls (3 rolls per per pack x 4)
  • Juvela fresh rolls white or fibre (5 rolls per pack x 8)* can be ordered in combination with fresh bread, 4 packs of each.
  • Just fresh good white rolls (4 rolls per pack x 6)
  • Glutafin gluten-free part-baked fibre rolls or white rolls (x 4 per pack)
  • Juvela fibre mix or white mix
  • Glutafin Select bread mix or fibre bread mix (500g)
  • Glutafin Select multipurpose fibre mix or multipurpose white mix (500g)
  • Glutafin pasta: conchiglie or fusilli or penne or spaghetti (500g); lasagne or tagliatelle (250g)
  • Juvela pasta: fibre penne or fusilli or macaroni or spaghetti (500g); tagliatelle or lasagne sheets (250g)
  • Barkat animal pasta shapes (500g) delivery costs are incurred with this product.
  • Glutafin crispbread (150g)
  • Glutafin mini crackers (175g)
  • Warburtons bran crackers (150g)
  • Juvela pizza base (2x180g)
  • Glutafin gluten-free pizza base (2x150g)
  • Juvela fibre flakes (300g)
  • Nairns gluten-free oat porridge (500g)
Prescribing Notes
  • Gluten-free foods that form part of a healthy balanced diet are required.  Gluten-free foods that are not normally required are biscuits, cakes and cake mixtures.
  • Gluten-free foods promote compliance to a gluten-free diet.  They provide nutrients that may not be readily available form other sources e.g. calcium and also support self management.
  • Some individuals with coeliac disease may require to avoid additional foods as well as gluten. It is important to check for additional allergies or intolerances (i.e. secondary lactose intolerance) or an unrelated allergy. The paediatric dietitian can provide additional information on the composition of prescribable gluten-free foods.
  • Currently many supermarket own brand breakfast cereals are suitable for a gluten-free diet, patients should be encouraged to cross check these in an up to date Coeliac UK food and drink directory.

  • Some companies charge pharmacies for delivery of these products.  This has been taken into account in the development of the formulary.  Prescribers should be aware that any non-formulary prescribing may incur delivery costs (i.e. prescribing costs) in excess of the individual cost of the product.
  • Dietitians may recommend other products on the ACBS list on the basis of nutritional need or where growth problems are identified, the reasons for this should be documented.
  • Ener-G xanthan gum can be prescribed for patients that do home baking. Delivery costs are incurred with this product.
  • All newly diagnosed patients should avoid all oat products for 6-12 months.  These should then only be re-introduced into the diet following the advice of a specialist clinician.