The safe threshold for gluten contamination in gluten‐free products. Can trace amounts be accepted in the treatment of coeliac disease?

Abstract

SUMMARYBackground: Gluten contamination in gluten-free products cannot totally be avoided. The safe threshold for gluten remains obscure. Aim: The purpose was to estimate a reasonable limit for residual gluten, based on current literature and measurement of gluten in gluten-free products on the market. Methods: The gluten content of 59 naturally gluten-free and 24 wheat starch-based gluten-free products were analysed by enzyme-linked immunosorbent assay. The daily intake of flours was calculated in 76 adults on gluten-free diet, and the intake compared with mucosal histology.

Opinion of the Scientific Panel on Dietetic products, nutrition and allergies [NDA] related to a notification from AAC on wheat-based maltodextrins pursuant to Article 6 paragraph 11 of Directive 2000/13/EC

“…In a study on coeliac disease, wheat starch-based gluten-free diet was compared to naturally gluten-free diet in 76 adult coeliac patients (Collin et al, 2004). The authors showed gluten contamination up to the level of 200 mg/kg of diet in both dietary groups.…”

Gliadins in Foods and the Electronic Tongue

“…In the standard Western European gluten-free diet, some gluten is accepted as a contaminant in wheat starch (Kupper, 2005). This starch improves the baking quality and palatability of the glutenfree diet and it is tolerated by most celiac patients (Collin et al, 2004;Fido et al, 1997;Goesaert et al, 2005;Peraaho et al, 2003). In other countries, such as United States of America, for example, wheat starch is not recommended.…”

“…More recently, foods labeled as "very low gluten" or "gluten-free" must have gluten content lower than 100 and 20 mg/kg, respectively (Nassef et al, 2008;OJEU, 2009;Zeltner et al, 2009). However, commercial foods labeled as gluten-free may be contaminated by gluten in the range of 20-200 ppm (Collin et al, 2004;Scognamiglio et al, 2014).…”

Is 'Gluten-Free' Gluten-Free? Celiac Disease in Canada 2015

“…There is an area of research concerned with the subset of patients for whom even a socalled "gluten-free diet" may be contaminated with enough gluten to cause symptoms or histopathologic change. 12 Several studies have sought to define a safe gluten threshold for CD patients; these have been summarized in two recent systematic reviews. 13,14 Unfortunately, these studies are heterogeneous in terms of study design, patient age, exposures, measurement techniques, and outcomes.…”