The Cost of Allergies - Uncle Sam Give Me a Break!

As your mom - I manage most of your health and so I know how expensive all this can be and those costs can add up really quickly, and we have reasonable health insurance. 

From the steep $600+ for an Epi-pen to thousands of dollars each month on food suitable for your long list of allergies and doctor appointment visits to ambulance rides and hospital stays. The costs are high and climbing.  Since I am a CPA, I often get questioned on taxes and credits, etc. The short answer is, I have no idea about taxes! Well I know enough to be dangerous and hold a conversation at a cocktail party. But this got me thinking, are any of the costs related to your allergies deductible?

I did some digging and the answer is Yes! And no.

First, what can we deduct:

• Co-pays
• Transportation costs, including mileage, using the standard mileage rate
• Parking 
• Overnight stays
• FOOD!

Yes, you read that right. The costs of special food can be deductible. The food must meet certain criteria. Those criteria include:

• The food must not be used to satisfy normal nutritional needs;
• The food must alleviate or treat an illness; and
• The need for the food must be substantiated by a physician

"The amount you can deduct as a medical expense is limited to the amount by which the cost of the special food exceeds the cost of a normal diet.  So, for example, if you buy special flour that costs $7/bag because of a wheat allergy and regular flour is $5/bag, you can only include the difference ($2) for purposes of calculating the deduction.  In other words, you cannot deduct the cost of all of your special food; you can only deduct the difference between the cost of your special food and your "normal" food.  If there is no such "normal" equivalent, however, the entire cost of the product is deductible."

Keep records to substantiate the claims. The expenses may be subject to phase outs, eligibility requirements and other limitations and we can only deduct those expenses which exceed 10% of our adjusted gross income (AGI).

What you cannot deduct:

• OTC medicines, even if doctor recommended, example: Motrin
• Non-prescription based personal care products, example: oatmeal bath, creams

The big take-away here is to track all of our expenses all year and if we meet the 10% floor of our AGI, we can start deducting. 

Ready, Set, Go Peanuts for the Baby!

Over the past decade, the prevalence of peanut allergies has exponentially increased.  For parents, children, families, physicians and teachers, there is significant frustration because the reason for this is still unknown.  There are many theories however, but nothing that is overwhelmingly responsible.  I will table this topic for another day. Back to the actual allergy to, rather than the cause - with this increase, peanuts are getting a lot of attention in the food allergy community and with that comes a lot of studies using them. One in particular, is known as the LEAP (Learning Early About Peanut) study. The study parameters, subjects and results were released in Q1 of 2015.

                                  

WHO: The subjects were infants (less than one year old) that were considered high-risk. High-risk equated to the infant having severe eczema (as described by the parent(s)), having a confirmed egg allergy or both.

WHAT: Some subjects will strictly avoid peanut protein until 60 months of age. The other group will receive peanut protein, regularly in their diet, multiple times per week until the age of 60 months.

ADDITIONAL INFO: Subjects were further stratified by sensitivity to peanut evidenced by a skin-prick test. Subjects experiencing a severe reaction to peanut at this point were dismissed from the study since they would likely be unable to consume the weekly requirement of peanut protein.

CONCLUSION: The results were remarkable. High-risk (eczema and/or egg allergic) infants showing mild sensitivity to peanuts or no sensitivity to peanuts via a skin-prick test that regularly ingested peanut protein until 60 months of age had a dramatically lower chance of developing an allergy to peanut when compared to the strict avoidance group.  There small window of opportunity to potentially change the infants sensitivity to peanut protein.

Ultimately what this study illustrated went against the American Academy of Pediatrics' (AAP) recommendation to delay peanuts.  The AAP has since revised their stance on the introduction of peanuts in high-risk infants.

In summary, at the earliest signs of eczema and/or egg allergy, an infant should be tested for a peanut allergy. If negative, introduce peanut products and have infant/child regularly consume following the LEAP protocol of at least two grams three times per week indefinitely.  If positive, complete the initial introduction of peanuts under medical supervision.

The Scratch that Itches and the Itch that Scratches

Jahan's eczema at seven months old

The correlation between eczema and food allergies although undeniable, is often not common knowledge to all.  Jahan's food allergy journey began shortly after birth with full body eczema covering his tiny body by five months old. Weeping, bleeding, itching, repeat. It's the scratch that itches and the itch that scratches.  We have had ups and downs, learning a lot along the way, but around the age of 14 months old, Jahan's baby skin was finally just that, soft and supple, like it's supposed to be.

This lasted for six short months and then a chest to knee flare began. Wet-wraps, diet revisions, elimination diets, creams and ultimately steroids. Ugh, that feels like the ultimate fail, having to resort to god awful steroids on my toddler's young and still thin skin.  All to end up back with an unwavering flare.  We opted to see our functional doctor, think east meets west, a holistic, natural MD.  The marriage of the two had produced some amazing results in the past, so I thought, lets get in to see Dr. Wong.

As we meet with Dr. Wong, Jahan is fearful, he must be thinking what will this doctor do to me. He has seen more doctors in his short two years of life than I have in my 32 years.

Right away Dr. Wong takes a look at the eczema and then scans Jahan's tongue and suggests eliminating cow diary. That's all milk, cheese, yogurt, mac n' cheese, string cheese, pirates booty, milk chocolate and the list goes on. We will switch to goat dairy, no problem since we live in an area where we have access to these foods and Amazon basically delivers same day now.  Dr. Wong also reminds us that Jahan's eczema is his body's way of showing the internal inflammation and suggests we complete a stool sample to see inside of his gut, where two-thirds of his immune system lives.  We agree.  Then Wong as Jahan calls him tells me that I have to prepare the samples at home, FedEx them overnight to the lab and wait.

Eczema flare at 22 months old before dairy elimination

So off we go.  Waiting for Jahan to have a bowel movement was our next step, which thankfully was only the next day (Saturday).  Jahan does his business and quickly I start in on this home scientific lab.  This was not fun.  Spooning fecal matter into various tubes, mixing and smoothing, repeat. They should really consider sending a mask home with this sample kit.  Not one of my finer mothering moments, but someone had to do it.

I package it up and off the stool goes to the lab for testing.

The results are in and right away from them I can see there are issues that need to be addressed. Inflammation. Leaky gut. Dysbiosis. Minimal bacterial diversity. And worst of all, two pathogens. Shit, how did this happen to my little guy? He was born vaginally, solely breastfed for 6 months, no antibiotics for the first year of life, probiotics from birth. He's only two!

Jahan's eczema and gut resolution regimen 

We circle back with Dr. Wong and he confirms everything from above.  Mehul and I are not interested in putting a "band-aid" on Jahan's symptoms, we want to solve the problems at the root. Wong knows this. He works to find "safe" supplements for Jahan's issues. This is quite the task given all of his food allergies, but ultimately we go home with our list of supplements and prescription to remove all dairy, even goat. So now Jahan is dairy free and ingesting 11 vitamins, supplements and herbs multiple times daily in hopes to improve the gut.

With this routine, the eczema has dissipated entirely with the exception of one stubborn patch.

And now we will continue the routine for eight weeks and then I get to spoon, smooth and smell the fecal matter of my adorable two-year old....again all while hoping we can stabilize Jahan's gut and entirely eradicate the scratch that itches and the itch that scratches.