Table 3.

Current findings and future challenges

Findings focused on patients with gluten-related disorders	Future challenges
Healthcare professionals
• Need to update gluten content databases to support prescription [10–17] • Definition of the role of pharmacists in the management of susceptible patients [7, 18] • Limited knowledge of pharmacists about celiac disease and its management [19] • Studies reporting initiatives addressed to or carried out by other healthcare professionals different from general practitioners or pharmacists were not identified	• Computerised decision-making support systems resulting in the generation of patient-specific assessments and recommendations for clinicians (e.g. algorithms and integrated alerts in the electronic prescription system) • Continuous disease-specific training and professionalisation of pharmaceutical care services (i.e. review of content for prescribed medicines in susceptible patients, and also non-prescription medicines and other pharmaceutical products) • Interoperability of electronic medical records between primary healthcare and pharmacies in order to identify susceptible patients before dispensation of medicines or other pharmaceuticals that could potentially contain gluten • Further robust studies are needed to assess the effectiveness of initiatives and strategies to increase awareness of gluten content of medicines
Patients
• Mistrust in manufacturers and/or healthcare professionals in case of adverse events related to gluten content of the medicines prescribed [21] • Unnoticed gluten intake through medicines [21]	• Patient training and empowerment to facilitate self-management, knowledge about the disease and the potential safety risks • Promoting a closer relationship with healthcare professionals and a collaborative partnership to ensure patients’ needs and preferences • Further robust studies are needed to assess the effectiveness of initiatives and strategies to increase awareness of gluten content of medicines as well as patient reported outcomes (i.e. quality of life, satisfaction)
Manufacturers
• Need to update the lists of manufacturers that never use gluten as excipient of medicines [10, 16, 17] • Awareness on incomplete medicine labels that could lead to adherence problems for patients and other safety issues (e.g. adverse events) [10–15, 17, 20] • Lack of gluten-free manufacturing policies [17] • Variability among countries on provided information and labelling of gluten content of medicines [10–17]	• Detailed list of all medicine components, explicit labelling in case of potentially harmful ingredients • Development of inherently gluten-free medicines and trace testing in final product • Inclusion of a wider spectrum of patients in clinical trials and design of development programmes for patients with celiac disease and other gluten-related disorders • Fostering worldwide cooperation and harmonisation (e.g. development of generic policies in relation to information on gluten content of medicines)
Medicines agencies
• Responsibility for gluten-free medicines policies [25, 27]	• Specific guidelines help to ensure a safe use of medicines available to patients with celiac disease and other gluten-related disorders and also to healthcare professionals • Fostering worldwide cooperation and harmonisation (e.g. development of generic policies in relation to information on gluten content of medicines) • Strategies for funding and maintaining a gluten-containing medicines research