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

Background: Celiac disease (CD) is a chronic autoimmune condition that, when left untreated, increases the risk of significant health challenges. The only medical treatment for CD is a strict gluten-free diet (GFD), which is behaviorally dependent. Despite quality of life (QOL) and adherence being impacted by the complicated and burdensome nature of the GFD, there exists a paucity of established behavioral interventions aimed to improve adherence and QOL in adolescents with CD. Aims: Develop and refine the Gluten-Free Resilience and Overall Wellness (GROW) Project, the first family-centered, online behavioral intervention to improve QOL and GFD self-management in adolescents with CD and their parents. Methods: Study staff adapted and refined an existing online behavioral intervention for adults with CD. Two rounds of interviews with patient, parent, and clinician stakeholders were conducted to collect feedback and inform the final intervention structure and content. Qualitative interview data were analyzed using inductive content analysis. Results: Stakeholder feedback supported a group-based, virtual format across both rounds of interviews. Participants proposed format changes to the intervention to increase participant engagement. Content suggestions included enhancing information about reliable digital resources, building resilience, GFD and alcohol, and the scientific development of the program. Conclusion: The GROW Project addresses a critical need for interventions that strengthen behavioral self-management strategies in adolescents with CD and their families by providing virtual skill-building and psychoeducation that may improve family's QOL while managing CD and the GFD.

INTRODUCTION: Determine contemporary rates of early mucosal recovery in children with celiac disease (CeD). METHODS: Multicenter retrospective cohort study in Canada and the United States. Children diagnosed with CeD between 2016 and 2021 who underwent a follow-up biopsy within 15 months of diagnosis were included. RESULTS: Overall, 96 of 130 children (74%) had mucosal recovery, including 48% children (12/25) who were assessed within 3 months. Musculoskeletal symptoms at diagnosis were the only clinical characteristic associated with persistent enteropathy. DISCUSSION: While mucosal recovery can occur within months, more than a quarter of children with CeD had persistent enteropathy within 15 months of treatment.

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.

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.