C eliac disease (CD) is a gluten-responsive inflammatory disorder with a worldwide prevalence of 1%. Avoiding gluten, a protein found in wheat, rye, and barley, is inherently challenging because gluten is ubiquitous, tasteless, and not always visible. Many patients with CD eat gluten-free (GF) food prepared in a home kitchen alongside gluten-containing foods. Fear of gluten exposure is common among CD patients and often leads to hypervigilance and decreased quality of life. 1 The Codex Alimentarius Commission defines GF as <20 parts per million (ppm) gluten. 2 GF diet guides published by professional societies, hospitals, and advocacy organizations suggest using dedicated toasters to prevent cross-contact with gluten and have conflicting recommendations regarding the need for dedicated utensils, leading to confusion for patients. 3,4 These recommendations are based on expert consensus with scant data to support them. 5 The aim of this study was to quantify gluten transfer when GF foods are prepared alongside gluten-containing foods. A secondary aim was to assess the efficacy of cleaning methods for kitchen equipment/utensils. Methods Three scenarios were developed to assess gluten transfer and efficacy of washing methods during food preparation: cooking pasta, toasting bread, and slicing cupcakes (Table 1).

Objectives: A gluten-free (GF) diet is the primary treatment for celiac disease (CD). Gluten is used in schools, particularly in early childhood, art, and home-economics classrooms. This study aimed to measure gluten transfer from school supplies to GF foods that a child with CD may eat. Also, to measure efficacy of washing techniques to remove gluten from hands and tables. Methods: Five experiments measured potential gluten cross-contact in classrooms: Play-Doh (n = 30); baking project (n = 30); paper mâché (n = 10); dry pasta in sensory table (n = 10); cooked pasta in sensory table (n = 10). Thirty participants ages 2 to 18 were enrolled. Following activities, gluten levels were measured on separate slices of GF bread rubbed on participant's hands and table surfaces. Participants were assigned 1 of 3 handwashing methods (soap and water, water alone, or wet wipe). Repeat gluten transfer measurements were taken from hands and tables. Gluten measurements made using R-Biopharm R7001 R5-ELISA Sandwich assay. Results: Paper mâché, cooked pasta in sensory tables, and baking project resulted in rates of gluten transfer far greater than the 20 ppm threshold set by Codex Alimentarius Commission. Play-Doh and dry pasta, however, resulted in few gluten transfers to GF bread >20 ppm. Soap and water was consistently the most effective method for removing gluten, although other methods proved as effective in certain scenarios. Conclusions: The potential for gluten exposure at school is high for some materials and low for others. For high-risk materials, schools should provide GF supplies and have a robust strategy to prevent gluten cross-contact with food.

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