Ask Dr. Weir – September 2021

This month’s “Ask the Expert” features Dr. Dascha Weir, MD, Associate Director, The Celiac Disease Program, Boston Children’s Hospital. Dr. Weir answers questions about gluten in personal care products and how to help your child after an accidental gluten exposure.

Question - I feel like we have finally gotten a handle on which foods are gluten-free (GF) and which are not GF. Then I read an article that suggested that in addition to food, I need to make sure my child is not exposed to gluten in soap, lotions, make-up and other personal care products? Do I also need to verify the GF status of my child’s personal care products?


Dr. Weir - It is important to remember that gluten needs to be ingested to cause immune activation and the small intestine inflammation and damage associated with celiac disease. People with celiac disease do not need to worry about gluten being absorbed through their skin.  However, many families worry that gluten in personal care products will make its way into their child’s GI tract.  While there could be potential exposure in some scenarios (for example, a child putting their fingers in their mouth or drinking bathwater), it is unlikely that significant amounts of gluten would be ingested in these situations because typically personal care products do not contain large loads of gluten. If a personal care product that your family uses has a gluten containing ingredient, you may choose to use an alternative product if one is available. However, you do not need to stick to certified gluten-free products only.  As always, we recommend hand-washing with soap and water before eating as another way to reduce small gluten exposures and spread of infection!  If your child is not doing well or you have specific concerns about their sensitivity to products, please reach out to your celiac team to discuss.

 
Question - My child went to a birthday party and ate one of the gluten containing snacks by mistake. She only ate a small amount when she realized her mistake. But she was still ill later that evening. For future mistakes, is there an over the counter medication that I can give her to lessen the impact of her exposure to gluten?


Dr. Weir - This is a common scenario that most families with a child with celiac disease have experienced at some point in time.  Even with all the planning, effort and vigilance that families put into avoiding gluten, mistakes can still happen. Kids with celiac disease have a wide range of symptoms when they ingest gluten. Typically, the symptoms are short-lived and get better with time and supportive measures such as rest, good hydration or curling up with a warm hot-water bottle.  Tylenol (acetaminophen) may be indicated to treat a headache or abdominal pain. If a child experiences significant vomiting with gluten exposure, some gastroenterologist will recommend a fast-acting anti-nausea prescription such as Zofran (ondansetron).  While there are over the counter medications available that claim to break down gluten, we do not recommend them for people with celiac disease either to prevent an exposure or to treat one. Increased and better options for treating children for gluten exposure may be available in the future as scientific discovery and medical practice is always advancing.

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