to the editor:Dr. Presutti and colleagues provided an excellent review of celiac disease. It is important to take a careful social history that includes alcohol intake when examining affected patients. Although many alcoholic beverages do not contain appreciable amounts of gluten, most commercially available beers do. In a study of various beers, gluten content was found to increase from alcohol-free beer (less than 3.0 mg per L) to lager beers (up to 8.7 mg per L), stouts (9.0 to 15.2 mg per L) to wheat beers (10.6 to 41.2 mg per L).¹ Patients with celiac disease should be educated that their diet should not include most beers.

in reply:We appreciate the comments by Dr. Grossman and agree that the social history, especially alcohol intake, is an important part of the evaluation of a patient suspected to have celiac disease. There is not a great amount of medical literature describing the beers that may be consumed by patients with celiac disease, but patients should be encouraged to review the Web sites listed in the patient handout as sources of information. An internet search for “gluten-free beer” also yields many listings of beers advertising to be free of gluten. However, patients should be cautioned to read labels carefully and pay close attention to the manufacturer's information when selecting a beer, especially for the first time.