A Quantitative Assessment of Gluten Cross‐contact in the School Environment for Children With Celiac Disease

Abstract

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.

Celiac Disease and Disorders of Gut–Brain Interaction: What School Nurses Need to Know

“…Because medication binders are an inactive ingredient, they may not be listed as an ingredient. While it is true gluten cannot be absorbed through the skin, ingestion is still possible after handling gluten if hands are not washed with soap and water (Children's National Hospital, 2023;Weisbrod et al, 2020). School health…”

“…Because medication binders are an inactive ingredient, they may not be listed as an ingredient. While it is true gluten cannot be absorbed through the skin, ingestion is still possible after handling gluten if hands are not washed with soap and water (Children’s National Hospital, 2023; Weisbrod et al, 2020). School health plans, including a 504 Plan as identified as Section 504 of the Rehabilitation Act of 1973 and/or Individualized Healthcare Plans, may be necessary to draw attention to the need for attendance accommodations or to allow students access to private restrooms and unlimited restroom access should they be experiencing symptoms (U.S.…”

Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review

“…A quantitative assessment of gluten cross-contact in the school environment for children with CD measured the gluten transfer from school activities to gluten-free foods that a child may eat afterwards [ 38 ]. Five experiments were used to identify potential gluten transfer to gluten-free bread in classrooms using sensory tables: Play-Doh, baking projects, papier-mâché, dry pasta, and cooked pasta.…”

Celiac Disease and Possible Dietary Interventions: From Enzymes and Probiotics to Postbiotics and Viruses

“…The GFD adherence rates are generally above 80–90% [ 53 ]. However, due to the wide use of wheat in most food ingredients, gluten can be difficult to avoid, resulting in accidental gluten exposure [ 54 ], as summarized in Table 1 . These difficulties of the GFD were highlighted by the Determination of Gluten Grams Ingested and Excreted By Adults Eating Gluten-free (DOGGIEBAG) study.…”