Three scenarios were developed to assess gluten transfer and efficacy of washing methods during food preparation: cooking pasta, toasting bread, and slicing cupcakes (Table 1). Table 1 Gluten Content of GF ^a Products containing <20 ppm gluten are eligible for a gluten-free label under the Codex Alimentarius Commission Standard. Pasta Cooked in the Same Pot as Gluten-Containing Pasta, GF Bread Toasted in Toasters Also Used for Gluten-Containing Bread and GF Cupcakes Cut With A Knife Used to Cut Gluten-Containing Cupcakes Preparation method Gluten undetectable <5 ppm Gluten detected 5–10 ppm Gluten detected 10–20 ppm Gluten detected >20ppm n (%) 95% CI n (%) 95% CI n (%) 95% CI n (%) 95% CI GF pasta Cooked in shared water (n = 12) 0 0–30 0 0–30 0 0–30 12 (100) 70–100 Cooked in shared water, then rinsed with cold water for 30 s (n = 6) 4 (66) 24–94 1 (17) 1–64 1 (17) 1–64 0 0–48 Shared pot washed with soap and water before cooking GF pasta (n = 6) 6 (100) 55–100 0 0–48 0 0–48 0 0–48 Shared pot rinsed with water before cooking GF pasta (n = 6) 6 (100) 55–100 0 0–48 0 0–48 0 0–48 Toaster GF bread toasted in communal rolling toaster (n = 20) 16 (80) 56–93 4 (20) 7–44 0 0–20 0 0–20 GF bread toasted in shared pop-up toaster (n = 20) 20 (100) 80–100 0 0–20 0 0–20 0 0–20 Cupcake GF cupcake sliced with knife used to cut gluten-containing cupcake (n = 30) 2 (7) 1–24 12 (40) 23–59 14 (46) 29–65 2 (7) 1–24 GF cupcake sliced with a washed knife 28 (93) 76–99 1 (3) 0.2–19 1 (3) 0.2–19 0 (0) 0–14 <!----> Soap and water 9 — 0 — 1 — 0 — <!----> Water alone 9 — 1 — 0 — 0 — <!----> Wet wipes 10 — 0 — 0 — 0 — CI, confidence interval. a Products containing <20 ppm gluten are eligible for a gluten-free label under the Codex Alimentarius Commission Standard. Open table in a new tab

INTRODUCTION: Treatment of celiac disease (CeD) requires a strict gluten-free diet (GFD). Adherence is difficult to assess and influenced by many factors. Identification of potential gluten exposures is essential, but no validated screening measures exist in pediatrics. The aim of this study was to develop and validate a measure screening for gluten exposure risk in pediatric patients with CeD. METHODS: The Gluten Exposure Risk Assessment (GERA) was developed in 3 phases. First, items were generated and refined by a modified Delphi process. Next, psychometrics, factor structure, and validity were examined in a sample of caregivers of pediatric patients younger than 18 years with CeD at 12 pediatric celiac centers. Finally, the final measure was tested on an independent sample population using confirmatory factor analysis and test-retest data. RESULTS: A total of 134 items were generated representing up to 6 domains, with 36 items selected for initial testing. Based on psychometrics and confirmatory factor analysis data from 484 caregivers, the final measure included a total of a single screening question and 9 validated items representing 2 domains (Home, Outside). Repeat testing on a separate sample (N = 369) confirmed factor structure and validity of the final measure (Comparative Fit Index = 0.96, Tucker–Lewis index = 0.95, root mean square error of approximation = 0.06). DISCUSSION: The GERA is a valid screening measure, completed by caregivers, for assessment of gluten exposure in children and adolescents with CeD following a GFD. GERA is a useful tool for evaluating the potential of risk of gluten exposure and potential need for intervention.

Objectives: We aimed to develop expert-informed recommendations for colleges and universities to support students with celiac disease (CeD) managing a gluten-free (GF) diet. Methods: A multidisciplinary panel of 40 stakeholders, including physicians, dietitians, a disability rights attorney, university staff, and students, was convened by the Celiac Disease Foundation to create expert-based and experience-informed recommendations. Over a 6-month period, the group conducted literature reviews, stakeholder interviews, and expert consensus discussions to identify common barriers and accommodations aligned with federal disability law. The expert panel collaboratively developed and revised an initial set of recommendations. Two rounds of structured voting were held during which panelists provided feedback to refine content and ensure clarity. All final recommendations were adopted with at least 90% of panelists voting in support. Results: The panel identified 24 accommodations across four domains: academics, housing, dining, and campus life. Academic recommendations include flexibility for illness-related absences, support for remote learning, and classroom modifications. Housing recommendations emphasize access to priority placement, appropriate appliances, and proximity to safe dining. Dining accommodations address GF food availability, ingredient transparency, staff training, and meal plan flexibility. Campus life recommendations ensure full participation in athletics, study abroad, social events, and internships, with supports for psychosocial well-being. Conclusions: This manuscript presents the first expert-informed recommendations focused specifically on the needs of college students with CeD. These recommendations are intended to support institutions as they develop strategies to enhance access to GF food, quality of life, educational supports, and student experience for those living with this chronic autoimmune condition.

Background: Shared fryers are commonly perceived as a high-risk source of gluten cross-contact for individuals with celiac disease (CeD), leading to widespread avoidance of foods such as French fries and tortilla chips. However, limited real-world data exist evaluating gluten concentrations in foods prepared in shared fryers under routine food service conditions. Because long-term health outcomes in celiac disease depend on minimizing cumulative dietary gluten exposure and intestinal injury is dose-dependent, characterizing gluten contamination from common dining practices has important implications for nutritional management and disease counseling. Objective: The aim of this study was to quantify gluten concentrations in naturally gluten-free (GF) foods prepared in shared fryers across U.S. food service establishments and to evaluate how fryer management practices, restaurant type, and geographic distribution influence gluten content. Methods: This cross-sectional observational study analyzed gluten concentrations in 98 samples of French fries (n = 55) and tortilla chips (n = 43) collected from fast food, fast casual, casual dining, and fine dining establishments, cafés, and other food service settings across multiple U.S. states. All samples were naturally GF prior to frying and prepared in fryers shared with gluten-containing foods. Gluten concentrations were measured using an enzyme-linked immunosorbent assay (ELISA). Recorded variables included sample type, restaurant type, state location, and fryer oil change frequency (daily, weekly, or unknown). In accordance with the U.S. Food and Drug Administration (FDA) GF labeling standard, foods containing <20 ppm gluten were considered GF, while values ≥20 ppm were classified as exceeding the GF threshold. Values <5 ppm were considered below the assay’s limit of quantification (LOQ). Results: Of the 98 samples analyzed, six (6.1%) exceeded the FDA GF threshold of 20 ppm. The majority of samples (84/98, 85.7%) measured below the assay’s lower LOQ (<5 ppm gluten). All 43 tortilla chip samples tested <5 ppm. Among samples from fast food establishments, 9/12 (75.0%) measured <5 ppm, 2/12 (16.7%) measured 5–20 ppm, and 1/12 (8.3%) exceeded 20 ppm. Among samples from fast casual establishments, 13/15 (86.7%) measured <5 ppm, 1/15 (6.7%) measured 5–20 ppm, and 1/15 (6.7%) exceeded 20 ppm. Greater variability was observed in casual dining establishments, including samples exceeding 20 ppm. All samples collected from establishments reporting daily oil changes measured <20 ppm, while samples from establishments reporting weekly oil changes demonstrated higher and more variable gluten concentrations, including values greater than 20 ppm. Conclusions: In this multi-site observational study, shared fryers were not uniformly associated with meaningful gluten cross-contact. Gluten concentrations varied by food service context and fryer management practices, with consistently low or below-LOQ gluten levels observed in establishments reporting daily fryer oil replacement, and greater variability observed in settings with less frequent oil changes. These results indicate that shared fryers are not inherently high-risk sources of gluten cross-contact and highlight daily fryer oil replacement as a key operational factor significantly associated with lower measured gluten levels. These findings have direct nutritional implications. Estimating gluten concentrations in shared-fryer environments allows for more accurate assessment of potential daily gluten intake, which is the key determinant of mucosal healing, serologic normalization, and long-term nutritional and health outcomes in individuals with celiac disease.