For Jen Smith, just feeding her family requires mind-bending effort — three times a day. That’s because her 8-year-old son Marty Smith is allergic to a host of foods, including those that contain or are cooked in peanut oil, soy or dairy.
He has a condition called eosinophilic esophagitis, which is exacerbated by food allergies and causes his esophagus to become inflamed.
To get dinner on the table, Smith, a teacher in Clovis, must carefully examine all ingredients and find recipes that work with her son’s limited diet. She ends up spending hours each week on extra food prep for her son and hundreds of dollars annually on specialty foods that her son isn’t allergic to.
Coping with food allergies can be daunting for any family, but, due to the extra labor and grocery costs, they often hit low-income families hardest.
“When you buy packaged foods expect the price to double or triple,” said Smith, who carefully budgets food expenses to feed her family of five on a teacher’s salary. “If I’m baking something with chocolate chips, I have to use a specific brand that is far more expensive. But it’s the only choice, because everything else is made with soy.”
The daily challenge
After a child is diagnosed with a food allergy, parents are often overwhelmed by figuring out which grocery items to buy, how to pay for them and what potential “trap foods” are also on the shelves, said Dr. Jonathan Tam, medical director of the Gores Family Allergy Center at Children’s Hospital Los Angeles.
Tam regularly sees patients in this situation. It’s one thing to diagnose someone with a food allergy and prescribe proper food avoidance strategies, but what many doctors don’t realize is that it can introduce a financial burden, he said.
“Food alternatives are expensive,” Tam said. “It’s great that we have tons of alternatives if somebody is allergic to something. ‘Gluten free’ wasn’t a thing when I was growing up. Now Gluten-free bread is everywhere, but it’s twice the price. And trying to find specific items can be difficult as they’re not all widely available.”
Dr. Tam sees most patients for the eight major types of allergies: milk (a full two percent of kids will have a milk allergy), peanut, egg, wheat, soy, tree nuts (like almonds, walnuts and pecans), fish and shellfish.
Research indicates that food allergies can hit low-income children the hardest. A study published in the April 2016 issue of Pediatrics, the journal of the American Association of Pediatrics, found that children with food allergies from households making less than $50,000 per year incur 2.5 times the cost of emergency room and hospital visits compared to peers with higher incomes.
Additionally, the study revealed that families making more than $100,00 per year report spending more of their own money on trips to specialists and medicines paid for out of pocket. Those are costs that, not surprisingly, are difficult for those with lower incomes to absorb.
An expensive diagnosis
There is no cure for food allergies. While there is promising research about the potential for some type of treatments, such an ongoing effort to develop a patch for those with peanut allergies, avoidance is the only current strategy.
This means that parents must be aware of so-called “trap foods” that contain the allergen. Tam said he trains parents on how to read labels and what to do if the child enters anaphylactic shock.
This can introduce another cost burden: the EpiPen, an epinephrine injector that can save someone’s life if they are having a severe allergic reaction.
“Insurance pays, but co-pays can be expensive,” Tam said. “The insurance may not pay for more than one, co you’re telling them to carry something around that’s very precious.”
While Medi-Cal, the state’s low-income health program, does provide coverage for an EpiPen, the cost and time involved in getting an approved replacement for the auto-injector is often difficult for low-income families, according to Tam. The price of the EpiPen continues to skyrocket, and there isn’t yet a clear alternative that is as effective, he said.
Medi-Cal also typically covers allergy testing, and the state’s food stamp program, CalFresh, generally allows people to purchase allergy-friendly items, such as gluten-free bread or lactose-free milk. The program even offers gluten-free recipe suggestions on an ancillary site that supports healthy eating.
A gap in assistance
Still, not all California’s low-income families have enrolled in CalFresh, and the state is working to improve access. Gov. Jerry Brown’s 2016 budget set a goal of enrolling 400,000 more children by the end of 2017.
Caroline Danielson, a senior fellow with the Public Policy Institute of California, co-authored a study published in December 2016 that explored the effort to improve access to better nutrition among California children.
“These resources are helping children directly in terms of getting them adequate nutrition and boosting family resources so a family in poverty that needs to repair a car or pay the month’s rent can do those things because they have assistance to buy food,” she said.
The time involved in planning and prepping allergy-aware meals can take its toll on families too, and there is no state assistance program for that. Even eating out is a chore, Smith said. Her son generally must stick to smoothies, steamed vegetables and French fries that aren’t cooked in soy oil.
“Planning vacations takes an act of God because I literally have to pack everything if I want him to have proper nutrition on our trip,” Smith said. “If we’re going for longer than a day, we have to bring healthy food in order for him to have more than just French fries.”