{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T22:01:05Z","timestamp":1789682465576,"version":"4.0.1"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T00:00:00Z","timestamp":1757462400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Background and aim<\/jats:title><jats:p>The prevalence and clinical spectrum of symptoms due to inadvertent gluten exposure in children with celiac disease (CeD) on a gluten-free diet (GFD) are not well defined. This study aimed to assess these acute reactions through an online survey.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Parents of children with CeD treated with a GFD for at least 12 months completed an online questionnaire. The survey focused on symptoms occurring within 24\u2005h of gluten-contaminated food ingestion.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Data were collected for 296 children. Acute reactions after unintentional gluten ingestion were reported in 98 cases (33.1%). The most common symptoms were abdominal pain (57.1%), diarrhea (42.9%), vomiting (31.6%), headache (12.2%), and fatigue (14.3%). Less frequent symptoms included nausea, constipation, urticaria, aphthous stomatitis, and arthropathy (each \u223c5%\u20137%). In 86% of cases, symptoms appeared within 2\u20133\u2005h. Gluten exposure most often occurred while dining out, especially in restaurants and school cafeterias.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>One-third of children with CeD on a GFD experience acute reactions to accidental gluten ingestion. These reactions typically arise rapidly and are dominated by gastrointestinal symptoms, aligning with reports from existing literature, where vomiting and nausea have been observed in 3%\u201346% of patients at the time of CeD diagnosis and in 13%\u201361% during gluten challenge.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2025.1635944","type":"journal-article","created":{"date-parts":[[2025,9,10]],"date-time":"2025-09-10T05:27:00Z","timestamp":1757482020000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of acute reactions to gluten contamination of the diet in children with celiac disease"],"prefix":"10.3389","volume":"13","author":[{"given":"Dorina","family":"Pjetraj","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise","family":"Damiani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Monachesi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salima","family":"Ricci","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Milena","family":"Ascani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simona","family":"Gatti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlo","family":"Catassi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Lionetti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,9,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2413","DOI":"10.1016\/s0140-6736(22)00794-2","article-title":"Coeliac disease","volume":"399","author":"Catassi","year":"2022","journal-title":"Lancet"},{"key":"B2","doi-asserted-by":"publisher","first-page":"53","DOI":"10.5409\/wjcp.v10.i4.53","article-title":"Celiac disease in children: a review of the literature","volume":"10","author":"\u015eahin","year":"2021","journal-title":"World J Clin Pediatr"},{"key":"B3","doi-asserted-by":"publisher","first-page":"115","DOI":"10.1038\/ajg.2015.398","article-title":"Prevalence of adult celiac disease in India: regional variations and associations","volume":"111","author":"Ramakrishna","year":"2016","journal-title":"Am J Gastroenterol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"412","DOI":"10.1177\/2050640618818227","article-title":"Rising prevalence of celiac disease is not universal and repeated testing is needed for population screening","volume":"7","author":"Levinson-Castiel","year":"2018","journal-title":"United European Gastroenterol J"},{"key":"B5","doi-asserted-by":"publisher","first-page":"63","DOI":"10.1053\/j.gastro.2020.06.098","article-title":"Epidemiology, presentation, and diagnosis of celiac disease","volume":"160","author":"Lebwohl","year":"2020","journal-title":"Gastroenterology"},{"key":"B6","doi-asserted-by":"publisher","first-page":"3993","DOI":"10.3390\/nu13113993","article-title":"The gluten-free diet for celiac disease and beyond","volume":"13","author":"Aljada","year":"2021","journal-title":"Nutrients"},{"key":"B7","doi-asserted-by":"publisher","first-page":"286","DOI":"10.1097\/mpg.0000000000001460","article-title":"Value of IgA tTG in predicting mucosal recovery in children with celiac disease on a gluten-free diet","volume":"64","author":"Leonard","year":"2016","journal-title":"J Pediatr Gastroenterol Nutr"},{"key":"B8","doi-asserted-by":"publisher","first-page":"781","DOI":"10.1097\/mcg.0000000000001946","article-title":"Symptom outcomes of celiac disease in those on a gluten-free diet","volume":"58","author":"Hujoel","year":"2023","journal-title":"J Clin Gastroenterol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"2244","DOI":"10.3390\/nu13072244","article-title":"Food safety and cross-contamination of gluten-free products: a narrative review","volume":"13","author":"Wieser","year":"2021","journal-title":"Nutrients"},{"key":"B10","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1016\/j.appet.2013.04.016","article-title":"Intentional and inadvertent non-adherence in adult coeliac disease. 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