Quantification of Accidental Gluten Contamination in the Diet of Children with Treated Celiac Disease
Open accessAbstract
A strict gluten-free diet is extremely difficult to maintain. Protracted ingestion of gluten traces (>10 mg/day) is sufficient to cause significant damage in the architecture of the small intestinal mucosa in patients on treatment for celiac disease. The aim of this study was to directly measure the level of contaminating gluten in the daily diet of celiac children following a gluten-free diet. From April 2019 to December 2019, celiac disease children (2–18 years old) on a gluten-free diet for ≥6 months were offered to participate in this prospective-observational study. Patients and their caregivers were invited to provide a representative portion (about 10 g) of all meals consumed during a 24-h period. Participants were requested to weigh all ingested food and report items in a 24-h food diary. The gluten content was quantified by the R5 sandwich enzyme-linked immunosorbent assay method. Sixty-nine children completed the protocol. Overall, 12/448 (2.7%) food samples contained detectable amounts of gluten; of them, 11 contained 5–20 ppm and 1 >20 ppm. The 12 contaminated food samples belonged to 5/69 enrolled patients. In these 5 children, the daily gluten intake was well below the safety threshold of 10 mg/day. The present findings suggest that in a country characterized by high celiac disease awareness, the daily unintended exposure to gluten of treated celiac children on regular follow-up is very low; reassuringly, the presence of gluten traces did not lead to exceed the tolerable threshold of 10 mg/day of gluten intake in the gluten-free diet.
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The prevalence of hazardous gluten content in products sold as gluten-free varies between studies in different countries: 6% in Australia, 10% in Ireland (the majority >100 mg/kg), and 0% in Italy.
“The prevalence of hazardous gluten content in products sold as gluten-free varies between studies in different countries: 6% in Australia(66), 10% in Ireland (67) (the majority >100mg/kg), 0% in Italy (60).”
From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [60]
The Discussion reports general conformity of gluten-free products marketed in Italy with labeling regulations. The Results report one sample above 20 ppm among 448 foods eaten by Italian children, but that sample was prepared at a relative’s home. This supports low contamination in the study’s Italian setting, not the stated 0% prevalence among products sold as gluten-free in Italy; this citation is attached to the Italy figure, not the Australia or Ireland figures. (LLM, conf=0.82)
Experimental — accuracy not yet measuredIn a study measuring gluten cross-contact in the daily diet of 69 children with coeliac disease and on a gluten-free diet, 2.7% of food samples contained detectable amounts of gluten, and one out of 448 collected food samples contained >20 mg/kg.
“A study aiming to measure the level of gluten cross-contact in the daily diet of 69 children with CD and on a GFD (60), food samples provided, 2.7% contained detectable amounts of gluten, and one out of 448 collected food samples contained >20mg/kg.”
In patients eating products with cross-contact food, the daily gluten intake was well below the safety threshold of 10 mg/day.
“In patients eating products with cross-contact food, the daily gluten intake was well below the safety threshold of 10 mg/day.”
Of the study participants, 7% had unintentional gluten intakes with levels ranging from 0.2-4 mg.
“Of the study participants, 7% had unintentional gluten intakes with levels ranging from 0.2-4 mg.”
Cleaning kitchen utensils, including knives, pots, ladles, and colanders, solely with water is enough to prevent cross-contact between kitchen utensils and gluten-free foods.
“Cleaning kitchen utensils, including knives, pots, ladles, and colanders, solely with water is enough to prevent cross-contact between kitchen utensils and gluten-free foods (60, 62).”
From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [60]
The Study Design and Results sections describe collecting and testing food eaten by children with celiac disease, not testing how utensils were cleaned. Searches for water-only cleaning, rinsing, and utensil cross-contact found no passage addressing whether water alone prevents gluten transfer. (LLM, conf=0.76)
Experimental — accuracy not yet measured
Using a shared knife to cut frosted cupcakes resulted in a gluten content >20 mg/kg in 2 of 30 (7%) samples.
“Using a shared knife to cut frosted cupcakes, resulted in a gluten-content >20 mg/kg in 2 of 30 (7%) (60).”
From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [60]
The Results report one sample above 20 ppm among 448 foods collected from children’s meals, not an experiment involving a shared knife. Searches for frosted cupcakes, a shared knife, and 2 of 30 samples found no passage addressing the claimed scenario. (LLM, conf=0.76)
Experimental — accuracy not yet measuredCooking gluten-free pasta in water where gluten-containing pasta had previously been cooked results in gluten content >20 mg/kg, depending on the portion and water volume.
“Cooking GF pasta in water where gluten-containing pasta had previously been cooked, results in gluten content >20 mg/kg (depending on the portion and water volume) (60,63) (60,63).”
From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [60]
The Results report that one of 448 food samples exceeded 20 ppm of gluten, but do not identify reused pasta water as its cause. Searches for cooking water, previously cooked pasta, portion size, and water volume found no passage addressing the claimed preparation method or its effect on gluten content. (LLM, conf=0.77)
Experimental — accuracy not yet measuredThe risk of cross-contact at home when toasting gluten-free bread in a toaster where gluten-containing bread has been toasted is low, as all samples tested in two studies had a gluten content well below 20 mg/kg.
“The risk of cross-contact at home when toasting gluten-free bread in a toaster where glutencontaining bread has been found to be low, as all samples tested in two studies had a gluten content well below 20 mg/kg (60, 64).”
From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [60]
The Results section reports gluten measurements in meals collected from children’s diets, not an experiment with gluten-free bread toasted in a shared toaster. A search of our copy for toaster use and toasted bread found no passage addressing that setting or the claimed results of two toaster studies. The one sample above 20 ppm was from the dietary survey, so it does not contradict the toaster-specific claim. (LLM, conf=0.76)
Experimental — accuracy not yet measuredWater and soap is effective to remove gluten when cleaning surfaces where gluten has been handled.
“Water and soap is effective to remove gluten when cleaning surfaces where gluten has been handled (60).”
From Gluten-free diet for pediatric patients with coeliac disease: A position paper from the ESPGHAN gastroenterology committee, special interest group in coeliac disease. (2024) · cites this paper as [60]
The Methods (§2.3) describe measuring gluten in food samples, and the Results (§3) report contamination in those samples. A search for water, soap, and cleaning gluten from surfaces found no passage in our copy that addresses whether this cleaning method is effective; page numbers were not provided. (LLM, conf=0.75)
Experimental — accuracy not yet measured
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Cites
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Luque, V., Crespo‐Escobar, P., Hård af Segerstad, E. M., Koltai, T., Norsa, L., Roman, E., Vreugdenhil, A., Fueyo‐Díaz, R., & Ribes‐Koninckx, C. (2024) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1002/jpn3.12079 · Cited by 32 · see citing works
- Authors
- Monachesi, C., Verma, A. K., Catassi, G. N., Galeazzi, T., Franceschini, E., Perticaroli, V., Lionetti, E., & Catassi, C.
- Affiliations
- Marche Polytechnic University (IT)
- Corresponding author
- Monachesi, Chiara
- Venue
- Nutrients
- Publisher
- MDPI AG
- Published
- 2021-01-09
- Volume
- 13
- Issue
- 1
- Pages
- 190
- ISSN
- 2072-6643 (ISSN-L)
- PMC
- PMC7827942
- OpenAlex
- W3119428170
- Cited by
- 15
- References
- 1
- Citations by year
- 2026: 4 · 2025: 2 · 2024: 4 · 2023: 2 · 2022: 2 · 2021: 1
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrients (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Università Politecnica delle Marche (Università Politecnica delle Marche) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Medicine › Gastroenterology › Celiac Disease Research and Management
- Health Sciences › Medicine › Immunology and Allergy › Food Allergy and Anaphylaxis Research
- Health Sciences › Medicine › Surgery › Eosinophilic Esophagitis
- Keywords
- celiac disease, gluten-free diet, children
- MeSH terms
- Adolescent, Celiac Disease, Child, Child, Preschool, Female, Food Contamination, Glutens, Humans, Intestinal Mucosa, Male, Patient Compliance, Diet Records, Diet, Gluten-Free
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