Classroom activities pose low risk of harmful gluten exposure in children with celiac disease

Common classroom activities – such as playing with Play-Doh or uncooked pasta – have little or no potential to cause harmful gluten exposure 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 Paediatric Gastroenterology, Hepatology and Nutrition, JPGN is published by Wolters Kluwer.

Other activities, such as working with papier-mâché or participating in baking projects using wheat flour, have higher potential for gluten cross-contact, according to the research by Vanessa Maltin Weisbrod, BA, CA, of Children's National Hospital, Washington, DC, and colleagues.

As a parent of a child with celiac disease myself, I've often worried about gluten exposure from art projects or other common classroom activities. 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."

Ms. Vanessa Maltin Weisbrod, BA, CA, of Children's National Hospital, Washington, DC

'Very low gluten transfer' after handling dry materials

In patients with celiac disease, eating gluten-containing foods provokes an immune response that can damage the intestinal lining. Due to concerns about gluten exposure, parents and schools may restrict children's participation in some activities using 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 years) handled gluten-containing materials: playing with Play-Doh modeling compound, doing a papier-mâché art project, playing with dried or cooked spaghetti in a sensory table, or baking cookies using wheat-based flour. After each activity, gluten transfer from the children's hands and table surfaces was measured.

The concern was not that gluten would be absorbed through the hands – gluten protein is too large to be absorbed through the skin. Rather, the study assessed the possible risk of "cross contact" with gluten transferred from hands or surfaces to foods that the children may eat.

The results showed "a very low or negligible risk" of gluten exposure after handling Play-Doh or dried pasta. "For years it has been assumed that children with celiac disease shouldn't play with Play-Doh, for example, because it has a high risk of gluten cross-contact," Ms. Weisbrod comments. "Our study provides quantifiable evidence that it doesn't."

In contrast, significant amounts of gluten transfer – more than 20 parts per million – were found after the children handled papier-mâché, cooked pasta, and cookie dough. "[W]e found that school supplies that are dry had very low gluten transfers while materials that were wet and sticky tended to cling to the hands of children and table surfaces," Ms. Weisbrod and coauthors write.

Even after the children handled wet or sticky materials, handwashing or cleaning the table surfaces eliminated gluten transfer. Washing with soap and water was "consistently the most effective method."

Celiac disease may affect about one percent of the world population – perhaps 740,000 school children in the United States. Celiac disease is managed by a gluten-free diet, but strict avoidance is difficult in a "gluten-filled world." "Gluten at school is often a source of anxiety for children with celiac disease and their parents," according to the authors.

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

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