Exposure to gluten from school supplies? Study assesses gluten risks in the classroom for children with celiac disease

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News — January 7, 2020 – Common classroom activities – such as playing with Play-Doh or uncooked pasta – have little or no potential to cause harmful exposure to gluten in children with celiac disease, reports a study in the Journal of Pediatric Gastroenterology and Nutrition (JPGN). Official Journal of the North American Society for Pediatric Gastroenterology, Hepatology and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology and Nutrition, JPG is published by Wolters Kluwer.

Other activities, such as working with papier-mâché or participating in baking projects using wheat flour, have a higher potential for gluten cross-contact, according to research by Vanessa Maltin Weisbrod, BA, CA, of Children’s National Hospital, Washington, DC, and colleagues. “As the parent of a child with celiac disease, I often worried about gluten exposure during art projects or other common classroom activities,” Weisbrod comments. “Our study provides reassurance that some of these activities pose a low risk of gluten exposure and that simple cleaning steps can further reduce the risk.”

“Very low gluten transfer” after handling dry materials

In patients with celiac disease, eating foods containing gluten triggers an immune response that can damage the intestinal lining. Due to concerns about gluten exposure, parents and schools may restrict children’s participation in certain activities that use gluten-containing materials.

The researchers designed an experiment to determine the true risk of gluten exposure from these activities. Thirty healthy children (average age 8) manipulated gluten-containing materials: playing with Play-Doh modeling clay, making a papier-mâché art project, playing with dried or cooked spaghetti on a sensory table or making cookies with wheat flour. After each activity, gluten transfer from children’s hands and table surfaces was measured.

The concern wasn’t that the gluten would be absorbed by the hands – the gluten protein is too large to be absorbed by the skin. Instead, the study assessed the possible risk of “cross-contact” with gluten transferred from hands or surfaces to foods children may eat.

The results showed “a very low or negligible risk” of gluten exposure after handling Play-Doh or dry pasta. “For years, it has been assumed that children with celiac disease should not play with Play-Doh, for example, because it poses a high risk of gluten cross-contact,” comments Ms. Weisbrod. “Our study provides quantifiable evidence that this is not the case.”

In contrast, significant amounts of gluten transfer – over 20 parts per million – were found after children handled papier-mâché, cooked pasta and cookie dough. “[W]We found that dry school supplies showed very low gluten transfer, while wet, sticky materials tended to cling to children’s hands and table surfaces,” write Ms. Weisbrod and coauthors.

Even after children handled wet or sticky materials, washing hands or cleaning table surfaces eliminated gluten transfer. Washing with soap and water was “always the most effective method”.

Celiac disease can affect around one percent of the world’s population – perhaps 740,000 schoolchildren in the United States. Celiac disease is managed on a gluten-free diet, but strict avoidance is difficult in a “gluten-filled world.” “Gluten at school is often a source of anxiety for celiac children and their parents,” according to the authors.

While activities using wet materials and wheat flour pose a risk of gluten transfer, the risks associated with other materials such as Play-Doh and dry pasta “may have historically been overestimated,” write Researchers. “[C]Children with CDs may be able to use these materials safely in the classroom environment, provided the materials themselves are not consumed.”

Ms Weisbrod and her co-authors discuss strategies schools can use to reduce the risk of gluten transfer during these activities – including some simple alternatives to gluten-containing materials. They conclude, “It is important that patients with CD and their parents continue to work closely with school administrators, teachers, and other educators to develop appropriate reasonable accommodations to mitigate the risk of gluten transfer into the classroom so that students can participate fully in all learning and social activities.

Click here to read “A Quantitative Assessment of School-Based Gluten Cross-contact for Children with Celiac Disease”

DOI: 10.1097/MPG.0000000000002588

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About Journal of Pediatric Gastroenterology and Nutrition

the Journal of Pediatric Gastroenterology and Nutrition provides a forum for original articles and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the digestive tract and its associated organs, including salivary glands, pancreas, gallbladder and the liver. Particular emphasis is placed on development and its relationship to infant and child nutrition.

About Wolters Kluwer

Wolters Kluwer (WKL) is a global leader in professional information, software solutions and services for clinicians, nurses, accountants, lawyers and the tax, finance, auditing, risk, compliance and regulation. We help our customers make critical decisions every day by delivering expert solutions that combine deep domain knowledge with advanced technology and services.

Wolters Kluwer had annual sales of €4.3 billion in 2018. The group serves customers in over 180 countries, maintains operations in over 40 countries and employs approximately 18,600 people worldwide. The company is headquartered in Alphen aan den Rijn, the Netherlands.

Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers and students with advanced clinical decision support, learning, research and clinical intelligence. For more information on our solutions, visit http://healthclarity.wolterskluwer.com and follow us on LinkedIn and Twitter @WKHealth.

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