Thursday, September 19, 2013

High Cost of Food Allergies

A recent study was released, estimating the gross annual cost of food allergies to American families in the aggregate.  This study is creating quite the buzz.  In the past couple of days, many articles have been written about this study by CNN, USA Today, CBS, LA Times, Salon, Medical News Today, and Fox News.  There are a probably a bunch more I missed.

All of this buzz is about a study published in JAMA Pediatrics led by Dr. Ruchi Gupta, a pediatrician at Ann & Robert H. Lurie Children's Hospital of Chicago and a professor at Northwestern University's Feinberg School of Medicine.  The researchers surveyed 1,643 parents in the U.S. who have a child with food allergies.  The results of the study are that $25 billion is spent each year on costs related to food allergies.

These costs are disproportionately born by the parents of the child, because they relate to things not covered by insurance, such as cost of food, opportunity cost to parents who have to forego work advancements and jobs, and childcare costs. None of this is news to food allergy parents though.

As a food allergy parent, the list of added costs associated with raising a child with food allergies includes:

  • Cost of specialty foods.
  • Child care- specifically, someone to come to the home, instead of using a daycare center or going to someone else's home.
  • Medicines, including 4 sets of epinephrine auto-injectors, one for the nurse at school, one for the kid at school, one for the kid to carry around outside of school, and the spare set at home, a nebulizer and medicine for the neb, a rescue inhaler, Benadryl, Benadryl cream, and steroids.
  • Bringing food everywhere we go.  Every family party, dinner, wedding, birthday, holiday, restaurant (if we dare), after school programs and activities, ball game, and other food containing events, require us to prepare and bring our daughter's own food.  This is true even if it is an event that charges a cover charge which includes food, like PTA events or dinner shows or events.  We basically pay for the dinner for our child and then she does not eat it.  Instead she eats a second dinner for which we also paid.
  • Many food allergy parents happily buy the whole class, troop, team, or group a treat, if it means their child is included and is safe. 
  • Lost job opportunities or fewer hours at the jobs we have, in order to go to doctors' appointments, to volunteer to be the room parent, or to be the snack mom at the ball games. 
These are the costs of keeping food allergy kids alive. The thing is that most parents will pay any price to  protect their children.  Food allergy parents are a great example of this. 

While the media immediately goes to questioning why the rates of food allergies have increased whenever they cover any food allergy related topic, including this one, I would love to see discussion of how we can change the tax laws to help defray some of these costs to families of children suffering from food allergies.  The current tax laws provide little or no benefit, as they do not include deductions for childcare, purchasing food for others in order to keep your child safe, or lost opportunities.  Maybe specialty food could be a separate deduction, not one lumped in with medical costs, with an unattainable threshold.   
    

Friday, September 13, 2013

Gleason v. United Airlines: Peanuts on Planes

As much as people like to complain about the legal system and perceived frivolous lawsuits, our legal system is one of the greatest ways to make changes for the better in this country.  All kinds of civil rights movements have started from lawsuits, whether successful or not.  Food allergies are now starting to surface in more lawsuits and I think we will see a shift in laws as a result of these suits in the next 5 years.

One of the suits I have been watching for about 4 months is the Gleason v. United Airlines case.  Alisa Gleason brought filed a complaint against United Airlines in the Eastern District of California (case no. 13-01064) after she suffered an allergic reaction to peanuts in flight and the flight needed to make an emergency landing in order for her to get treated for her full blown anaphylactic reaction.

Alisa has a severe peanut allergy.  According to her complaint, Alisa called United Airlines' customer service prior to purchasing her ticket to ask whether accommodations would be made for her peanut allergy if she travelled on the airline.  She claims that she then purchased the ticket from Orland to Sacramento.  She alleges that the United Airlines customer service agent told her to tell the agent at the ticket counter about her allergy and then the allergy would be accommodated, including an announcement to the other passengers that a passenger has a severe peanut allergy. 

Alisa claims that when she arrived at the ticket counter, she informed the agent of her peanut allergy, but the agent told her to remind the head flight attendant aboard her flight of her severe peanut allergy and that her condition would need to be accommodated.  Then she says she told the head flight attendant of her allergy and requested a peanut free flight, but the flight attendant told her that no announcement regarding the allergy would be made.  The reason she was given was that United Airlines could not accommodate every kind of allergy.  Alisa claims that the head flight attendant did tell her that no peanut products would be distributed in the flight, so she remained on the flight.

Alisa alleges that one hour in to the flight she began to experience difficulty breathing and swallowing and administered the Epi-pen.  Her condition then rapidly deteriorated and she lapsed in and out of consciousness.  Another passenger alerted the flight crew to Alisa's condition and told them that she would not survive the remaining 45 minutes of the flight.  The flight then made an emergency landing in Missouri where Alisa was transported to the hospital.

Stories in the press covering this incident claim that there was a woman who was eating peanuts and that she would not have eaten them if she knew there was another passenger with a peanut allergy.

United so far denies the allegations, but says it is still investigating.  The complaint was filed in May 2013 and probably won't go to trial until 2014.    Alisa has demanded a jury trial.

If this suit makes it to trial, it could determine what, if any, accommodations an airline must make for travelers with severe allergies. 

Wednesday, September 11, 2013

The Rules on Tax Deductions for Special Food Necessary Because of Food Allergies

You may have heard that if a food is medically necessary because of life threatening food allergies, it is tax deductible.  This is true, but there are steep thresholds before you will have any real tax savings.

First, the food must be medically necessary and must cost more than the food it is substituting.  Some examples of what might constitute a medically necessary substitute is soy milk, in lieu of cow's milk, due to a life threatening milk allergy; gluten free flour in lieu of wheat flour, due to a life threatening wheat allergy; or Sunbutter in lieu of peanut butter, due to a life threatening peanut allergy.  The allergy must be diagnosed by the doctor and the doctor must recommend strict avoidance.  That last part is a given with life threatening food allergies. 

Second, you may only deduct the cost of the product that is above and beyond what the product you are substituting costs.  So, if soy milk costs $5.00 per gallon and cow's milk is $2.00 per gallon, then you get a $3.00 deduction for each gallon of soy milk you buy.  You have to save the receipts, keep a log of the purchase price, estimated price of food you are substituting, and difference.  As you can imagine, this can be tedious.  Imagine doing this for every single allergy substitute product you purchase for a whole year.  But, if you made it part of your routine when you return from the grocery store to take the receipt and put the numbers in the spreadsheet, then the process may be able to work its way into your routine.

Third, for the first 10% of your adjusted gross income worth of food deductions, you get no actual tax deduction.  Your adjusted gross income is found on Line 37 of tax form 1040.  If you make $70,000 per year, you would have to have $7,000 in food deductions for which you receive no tax deduction first, and then on the $7,001 dollar in food deductions you can deduct one dollar, and then every dollar after that above the $7,000 threshold.  If you make $100,000, then your threshold is $10,000, and so on.  

Is it worth all of the effort?  That depends on your gross income and how much extra you spend on your allergic kid.  However, since this deduction is not limited to food for food allergies, you can also deduct your other medical expenses, which might help you reach the threshold faster.  You can deduct any co-pays or out of pocket costs your insurance does not cover.  You can deduct the deductible you had to pay before your insurance kicked in.  This applies to all medical expenses, including doctors, dentists, and eye doctors.  Medical devices such as nebulizers count.  Prescription drugs count.  Maybe it was a bad year and someone in your family was hospitalized or maybe you had a baby.  A 10% copay in those circumstances can be substantial.  If you or your spouse lost your job and your income went down, so would your threshold.  The food deduction might just push you across the threshold into a real money deduction.  For many people, though, it is probably not worth the effort. 

Wednesday, September 4, 2013

Are you kidding, Milk in Chalk? One More Consideration for 504 Plans

This past Spring 2013, results of a study conducted in
Spain were released, which concludes that children with milk allergies may react to the dust from chalk in their schools.  Why?  Because the common chalk used by schools and teachers contains the milk protein casein.  Yes, milk in chalk.  That means children can breath in the allergen and have an allergic reaction.  The study is summarized at this link:  Milk in Chalk. 

To be specific, the chalk in question is called "no dust" or "low dust" or "anti dust" chalk.  The formula to eliminate the dustiness of chalk apparently includes milk.  A simple Google search revealed that this has been covered in the press a lot actually.  See this recent article from just a couple of weeks ago.  The study showed that children with a milk allergy could have an allergic reaction from breathing in the chalk particles in the air, but I wonder if anyone has studied what happens if the children use the chalk and get it on their hands or what happens if they get it in their mouths, from cross contact with their hands or directly.  I have even more questions, such as whether the study examined the most severely milk allergic kids who have anaphylactic allergies to small amounts of protein or those with severe asthma, who are probably already sensitive to regular chalk dust particles.        

Legally, what does all of this mean?  Well, first, because chalk is not a food, Milk or any other allergen does not need to be included on the chalk's label.  In other words, you will have no warning that this product may cause a reaction in your milk allergic kid.  It might also explain mystery reactions or asthma attacks your child may have had at home or school.

This is something that should be raised in discussing the 504 Plan with your school if your child is allergic to milk.  Ask whether the school has any chalk boards, either on the walls or portable, and if so, what kind of chalk is used.  Ask the school to contact the manufacturer and get a written statement as to whether the chalk contains casein or any milk protein.  Restrict the chalk from any room or environment in which your child is located during the school day, not just when your child is in the room.  If the dust is spread around the room before your child enters, it still has a chance of coming into contact with your child.  Ask about art projects which might contain chalk. 

This definitely leaves me wondering what else contains milk protein that we don't know about.