Managing coeliac disease and severe allergy in Spain

Key rules

• Referral: You reach the public allergy service through your GP or paediatrician, not directly.
• Auto-injector cost: Active workers pay 40% of the price and pensioners pay 10%, capped monthly.
• Renewal: Renew the electronic prescription every 12 to 18 months, or after use.
• Gluten-free food: The public system does not pay for gluten-free food nationally; regional aid varies.
• Allergen information: Restaurants and bars must make allergen information available for all 14 listed allergens.

Start with your GP

Your GP (or your child's paediatrician) is the door to everything here. For allergies, they refer you to the hospital allergy service (alergología). For coeliac disease, they start the tests and refer you on. The checklist below lists the steps in order.

Setting up allergy follow-up

The allergy service covers diagnosis (skin tests, blood tests, challenge tests), immunotherapy, and follow-up for food, drug, venom and respiratory allergy.

Waits for a first appointment vary by region and hospital. They can run from weeks to many months. Ask your GP how long the wait is where you live.

If you have a severe reaction (anaphylaxis), go to emergency care. You are referred to the allergy service afterwards.

Adrenaline auto-injectors

A GP or allergist can prescribe an adrenaline auto-injector, normally after an allergy diagnosis. Brands you may be offered include EpiPen, Jext and Altellus.

• The prescription is electronic. The pharmacy dispenses the device against it.
• It is a subsidised medicine. Active workers pay 40%. Pensioners pay 10%, capped monthly. People on exemption schemes may pay nothing.
• Devices expire, usually every 12 to 18 months. Renew the prescription before the expiry date. Replace the device after any use too.

Put the expiry date in your phone calendar when you collect the device.

Coeliac disease

The public system covers diagnosis and follow-up. That means a blood test first, then a specialist assessment, and usually a biopsy. Follow-up is through primary care, digestive medicine or paediatrics.

Gluten-free food is not funded nationally, so you will mostly pay the extra cost yourself. A few regions have had limited aid schemes. Ask your regional health department what exists where you live. Some costs may also be eased through tax deduction rules. These are not a general entitlement. The Federation of Coeliac Associations of Spain (FACE) campaigns on this and can point you to local groups.

Eating out and reading labels

Spain follows the EU list of 14 allergens: cereals containing gluten, crustaceans, eggs, fish, peanuts, soy, milk, tree nuts, celery, mustard, sesame, sulphites, lupin and molluscs.

• Packaged food: the allergens are emphasised in the ingredients list, for example in bold.
• Restaurants, bars and bakeries: allergen information must be available in writing or by another clear means. If it is given orally, a notice must say where to ask.

If staff cannot tell you what is in a dish, do not take the risk. Choose something else. The FAQ below covers this case.

Timeline and deadlines

• Get your allergy diagnosis and an auto-injector prescription from your GP or allergist: after your allergy diagnosis

• Collect the auto-injector from the pharmacy with your electronic prescription: as soon as it is prescribed

• Renew the prescription and replace the device when it expires: every 12 to 18 months

• Ask for a new prescription and replace the device: right after you use it

Checklist

• Ask your GP or paediatrician for a referral to the hospital allergy service (alergología).

• Ask your GP or allergist for an electronic prescription for an adrenaline auto-injector.

• Collect the auto-injector at the pharmacy and check what contribution applies to you: 40% for active workers, 10% for pensioners, or nothing under an exemption scheme.

• Ask your GP, digestive medicine or paediatrics service for coeliac blood tests and specialist follow-up.

Frequently asked questions

How much will I pay for an adrenaline auto-injector?

You pay a 40% contribution if you are an active worker, or 10% (capped monthly) if you are a pensioner. People on exemption schemes may pay nothing. A GP or allergist issues an electronic prescription, and the pharmacy dispenses the device.

What do I do if a restaurant cannot tell me what allergens are in a dish?

Ask for the written allergen information, which restaurants, bars and bakeries must make available in writing or by other clear means. If staff give it orally, a notice must show where to ask.

How long will I wait for my first allergy appointment?

Waits for a first allergy appointment range from a few weeks to many months, depending on your region and hospital. Your GP or paediatrician makes the referral.