It is officially springtime. The sun is shining, the birds are singing and green things are -- yikes! -- blooming once again.
While many look forward to a fresh season, those with allergies may approach springtime with caution and Kleenex. And they might suffer even more because of their location.
The Asthma and Allergy Foundation of America released its annual list of the Top 100 most challenging places to live with spring allergies for 2008 last week.
The AAFA used pollen counts and medication utilization data from last year and the number of board-certified allergists per patient in an area to rank the 100 largest cities in the country.
These criteria counterbalanced each other, according to Mike Tringale, director of external affairs for the AAFA. When the pollen count or medication usage is very high, a city will move up in the ranks. However, if there is a large number of allergists available to treat those affected, the city's ranking will drop.
Tringale said that this is the AAFA's sixth year creating this report and that they look at the same 100 cities each year.
"We definitely see regional consistency," Tringale said, adding that cities in the Southeast are hit hardest with allergies in the spring while fall allergies are worse in the Northeast.
Though the AAFA takes three specific criteria into account when ranking cities, allergists point out that factors such as rainfall, winds and indoor allergens can contribute to allergies. Allergies have become the third most common disease of childhood, according to Beth Miller, division chief of allergy and immunology at the University of Kentucky in Lexington.
"You have to have the right genetic potential, the right exposure," Miller said. "But there are lots of things allergists can do to improve your life."
While allergists agree that the best course of action for a person with allergies is avoidance, that is not always a viable option. In those cases, working with an allergist to get proper treatment, like allergy medications or immunotherapy, is vital.
The following are the Top 10 most allergy ridden cities to live in from the AAFA's annual list.
10. San Diego
Rank last year: 54
San Diego has some of the most pleasant, least-variable weather in the United States. But increased rain and fires in the past year may have contributed to the city's rank as the 10th most challenging place to live with allergies.
After the massive fires in southern California, including much of San Diego County, as well as an average rainfall, many of the area's trees gave way to pollen-producing grasses and weeds, said Stephen Wasserman, professor of medicine at the University of California at San Diego.
"I think each city has its own allergic issues," Wasserman said.
Olive trees, for example, are large pollen producers for the area that is not seen in other parts of the country, Wasserman said.
9. Little Rock, Ark.
Rank last year: 8
The capital and most populous city in Arkansas got its name from a small rock formation on the bank of the Arkansas River called la petit roche, or the little rock. The humid, subtropical climate of the area is characterized by short, mild winters and hot humid summers. A variety of flowering trees, grasses and wildflowers lend themselves to allergy season.
Though the city scored average for pollen, high medication use and a low allergist-to-patient ratio kept Little Rock in the AAFA's Top 10 cities where living with allergies can be challenging.
8. New Orleans, La.
Rank last year: 58
The birthplace of jazz, known for music, Mardi Gras and one of the most unique cultures in the United States is also an hotbed of allergens. According to the AAFA, New Orleans had worse than average rates of medication utilization and a low allergist-to-patient ratio.
And though the pollen count was average compared to the rest of the cities in the AAFA report, the aftermath of Hurricane Katrina continues to affect allergy sufferers.
"The low allergist number is still due to the storm," said Felicia Rabito, clinical associate professor of epidemiology at the Tulane School of Public Health and Tropical Medicine. "Our health-care infrastructure is not back after the storm."
New Orleans is a humid, semitropical climate with many indoor and outdoor allergens. But after the storms, with many properties left to fester, overgrowing weeds and grasses in many parts of the city may have contributed to New Orleans' rank this year.
Rabito is part of an ongoing study to determine whether people who are not normally allergic are now becoming allergic to the increased number of allergens.
7. Birmingham, Ala.
Rank last year: 23
Located at the foothills of the Appalachian mountains, Birmingham grew so much and so quickly at the turn of the century that it got the nickname The Magic City.
But with more green spaces per capita than any other city in the country, it is no wonder that living with allergies in Birmingham can be a challenge. The city had high pollen counts, high incidence of medicine use and a low allergist-to-patient ratio.
6. Knoxville, Tenn.
Rank last year: 63
Knoxville has a rich cultural heritage, part of which earned it the nickname The Underwear Capital of the World. This name came about because the city was home to a large number of clothing mills and textile companies in the 1930s.
If those mills were still operational, they might be successful if they manufactured handkerchiefs for those with allergies in the area.
Knoxville had an average pollen score as well as an average number of allergists in the area. However, the medication utilization score was very high, greater than the average usage, which, according to the AAFA, averages two types of medication per person.
5. Jackson, Miss.
Rank last year: 30
Located on the Pearl River, Jackson is the capital of Mississippi. Cities in this part of the country are the "ideal environment for pollens and mold," Miller said.
Like much of the Southeast, Jackson has heat and humidity, which lends itself to a high incidence of ragweed and other pollen-producing plants, as well promoting indoor allergens.
The city had both high rates of pollen and medicine utilization in the past year, according to the AAFA's report.
4: Augusta, Ga.
Rank last year: 11
Perhaps its nickname, The Garden City of the South, is an indication that Augusta, Ga., may not be the most allergy-friendly city. Higher-than-average pollen counts and incidence of medicine usage nudged the city into the top 10 of the AAFA's list compared to last year.
Augusta adapted the motto "we feel good" and erected a statue downtown in honor of soul singer James Brown who made his home here. However, allergy sufferers in Augusta may identify more with Brown's music than his message.
3. Johnson City, Tenn.
Rank last year: 61
Davy Crockett, a famed American frontiersman, was born in a small house outside Johnson City, Tenn. If he suffered from allergies, he might not have been the great explorer and trapper that he was in the late 1700s.
But perhaps Johnson City was less challenging to live in with allergies than it is today.
According to the AAFA report, Johnson City had a below-average rate of medicine utilization compared to the other cities on the list, although their pollen counts and number of allergists were average.
2. Greensboro, N.C.
Rank last year: 29
Greensboro holds a prominent place in American history as the site of the lunch-counter sit-in strikes during the civil rights movement in the 1950s and 1960s
Though not quite as notoriously, Greensboro also holds a place this year as the second most-challenging place to live with spring allergies.
While there is an average number of allergists in the city, Greensboro had high pollen counts as well as high rates of medication utilization.
1. Lexington, Ky.
Rank last year: 52
Lexington, the Horse Capital of the World, scored worse than average in all three rating categories. It has an abundance of pollen, high incidence of allergy medication usage, both prescription and over-the-counter, and too few allergists in the area to treat those affected.
"We are one of the worst cities for allergy," said Miller. Miller said that the seasons in that part of the country are short, with different types of pollens peaking in cycles, one after the other. As soon as residents acclimate to one type of pollen, they must adjust to another type.
In addition, the weather around Lexington this year -- early warm weather without a frost -- may have also contributed to the high pollen count.
But Miller said Lexington, with its mild winters, is a very good place to live, climatewise. And since the severity in winter can vary from year to year, Miller added that taking an average pollen count over several years might have been more accurate.
"Just because you have allergies doesn't mean you can't live in Lexington," Miller said.