{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:02:43Z","timestamp":1789642963662,"version":"4.0.0"},"reference-count":93,"publisher":"MDPI AG","issue":"18","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Background: Pediatric celiac disease (CD) prevalence is rising, estimated at 2% to 3% in select screening cohorts. Affected children face significant environmental, psychosocial, and nutritional barriers within institutional school settings. Methods: This narrative review synthesizes published clinical trials, cohort studies, and food science data to examine infrastructure vulnerabilities and care gaps within educational environments. Results: High-volume school kitchens present potential mechanical cross-contact risks via convection currents and shared equipment. Standard alcohol hand sanitizers demonstrate negligible mechanical or chemical efficacy against inert gliadin proteins, suggesting the need for surfactant-based washing protocols. In classrooms, tactile wheat-based materials introduce non-dietary ingestion pathways. These collective environmental challenges may contribute to social exclusion, peer stigmatization, and heightened risks for childhood mood variations. Furthermore, many commercial gluten-free alternatives lack routine fortification, potentially compounding celiac-related micronutrient deficiencies. Conclusions: Reactive, individualized accommodations may provide insufficient protection. Improving student safety and well-being supported by this narrative evidence points toward a general framework of structured kitchen guidelines, universal classroom adaptations, and jurisdiction-dependent administrative coordination.<\/jats:p>","DOI":"10.3390\/nu18183042","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T09:59:03Z","timestamp":1789639143000},"page":"3042","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Celiac Disease Management in School Environments: An Interdisciplinary Narrative Review of Operational, Psychosocial, and Nutritional Barriers"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9833-8477","authenticated-orcid":false,"given":"Alexandra","family":"Mpakosi","sequence":"first","affiliation":[{"name":"Department of Immunology, General Hospital of Nikaia \u201cAgios Panteleimon\u201d, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vasileios","family":"Cholevas","sequence":"additional","affiliation":[{"name":"School of Medicine, University of Bologna, 40126 Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stamatios","family":"Cholevas","sequence":"additional","affiliation":[{"name":"School of Pharmacy, European University of Cyprus, Diogenes 6, Engomi, 2404 Nicosia, Cyprus"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Argyro","family":"Pastrikou","sequence":"additional","affiliation":[{"name":"Department of Immunology, General Hospital of Nikaia \u201cAgios Panteleimon\u201d, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aikaterini","family":"Fragkiadaki","sequence":"additional","affiliation":[{"name":"Department of Immunology, General Hospital of Nikaia \u201cAgios Panteleimon\u201d, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-6168-3217","authenticated-orcid":false,"given":"Foteini","family":"Tziraki","sequence":"additional","affiliation":[{"name":"Department of Immunology, General Hospital of Nikaia \u201cAgios Panteleimon\u201d, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Vogiatzis","sequence":"additional","affiliation":[{"name":"Department of Immunology, General Hospital of Nikaia \u201cAgios Panteleimon\u201d, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8588-8672","authenticated-orcid":false,"given":"Alexandra","family":"Lianou","sequence":"additional","affiliation":[{"name":"Neonatal Intensive Care Unit, General Hospital of Nikaia \u201cAgios Panteleimon\u201d, 18454 Piraeus, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ioannis","family":"Tzouvelekis","sequence":"additional","affiliation":[{"name":"School of Agricultural Technology, Food Technology and Nutrition, Alexander Technological Educational Institute of Thessaloniki, 57400 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2102-766X","authenticated-orcid":false,"given":"Thomas","family":"Rallis","sequence":"additional","affiliation":[{"name":"Thoracic Surgery Department, \u201cTheageneio\u201d Cancer Hospital, 54639 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Mironidou-Tzouveleki","sequence":"additional","affiliation":[{"name":"Department of Pharmacology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3695-0759","authenticated-orcid":false,"given":"Andreas G.","family":"Tsantes","sequence":"additional","affiliation":[{"name":"Laboratory of Haematology and Blood Bank Unit, \u201cAttikon\u201d Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9972-8901","authenticated-orcid":false,"given":"Rozeta","family":"Sokou","sequence":"additional","affiliation":[{"name":"Neonatal Department, Aretaieio Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1016\/j.yapd.2008.07.001","article-title":"Celiac Disease: Pathophysiology, Clinical Manifestations and Associated Autoimmune Conditions","volume":"55","author":"Barker","year":"2008","journal-title":"Adv. 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