Food Safety and Cross-Contamination of Gluten-Free Products: A Narrative Review.

Herbert Wieser,Carolina Sousa,Verónica Segura,Ángela Ruiz-Carnicer,Isabel Comino

doi:10.3390/nu13072244

Abstract

A gluten-free diet (GFD) is currently the only effective treatment for celiac disease (CD); an individual’s daily intake of gluten should not exceed 10 mg. However, it is difficult to maintain a strict oral diet for life and at least one-third of patients with CD are exposed to gluten, despite their best efforts at dietary modifications. It has been demonstrated that both natural and certified gluten-free foods can be heavily contaminated with gluten well above the commonly accepted threshold of 20 mg/kg. Moreover, meals from food services such as restaurants, workplaces, and schools remain a significant risk for inadvertent gluten exposure. Other possible sources of gluten are non-certified oat products, numerous composite foods, medications, and cosmetics that unexpectedly contain “hidden” vital gluten, a proteinaceous by-product of wheat starch production. A number of immunochemical assays are commercially available worldwide to detect gluten. Each method has specific features, such as format, sample extraction buffers, extraction time and temperature, characteristics of the antibodies, recognition epitope, and the reference material used for calibration. Due to these differences and a lack of official reference material, the results of gluten quantitation may deviate systematically. In conclusion, incorrect gluten quantitation, improper product labeling, and poor consumer awareness, which results in the inadvertent intake of relatively high amounts of gluten, can be factors that compromise the health of patients with CD.

Highlights

The consumption of gluten proteins drives adverse reactions in predisposed individuals who suffer from celiac disease (CD), wheat allergies, non-celiac gluten sensitivity, dermatitis herpetiformis, or gluten ataxia [1,2,3]
Contaminated naturally gluten-free products appear to be a higher health risk than certified products for patients with CD. Both naturally and labeled gluten-free foods do not guaranty safety for patients with CD, and gluten contamination is an important cause of inadvertent non-adherence to a gluten-free diet (GFD)
Patients with CD should be aware of numerous composite foods, medications, and cosmetics that contain “hidden” sources of so-called vital gluten (VG), a by-product of wheat starch production

Summary

Introduction

The consumption of gluten proteins drives adverse reactions in predisposed individuals who suffer from celiac disease (CD), wheat allergies, non-celiac gluten sensitivity, dermatitis herpetiformis, or gluten ataxia [1,2,3]. A strict gluten-free diet (GFD) is currently the only safe and efficient therapy for patients with CD [7,8], which implies that all gluten-containing foods and meals, produced from wheat, rye, barley, and some varieties of oats, must be completely excluded from the diet. Such a diet is difficult to follow because of the unintended contamination of “gluten-free” products, improper labeling, social constraints, and ubiquity of gluten proteins in raw or cooked food and pharmaceuticals. There is a tremendous degree of variability within this population, and some patients may have worsening histological changes with very low daily gluten exposure [9,10]

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