To the allergy-free person, red eyes and stuffy noses may look like mild discomforts amplified by whiners and drug companies. But for the victims of outdoor allergies, the dreaded pollen of spring and fall can drive people to desperate measures.
"People are struggling with allergies so much that they're willing to move," said Angel Waldron, communications manager for the Asthma and Allergy Foundation of America (AAFA). "We speak to consumers daily and that's probably the most popular question I can get it: 'where can I move to make this better?'"
After years of such phone calls, the AAFA decided to make an annual list of the most challenging places to live with fall allergies. The list takes into account pollen levels, how much allergy medications residents buy and how many allergists are in the city to help.
However, allergists say when, where and how hard pollen strikes each year depends on many more criteria than the AAFA used.
"Ragweed pollinates in different parts of the country at different times," said Dr. Harold Nelson, an allergist at National Jewish Health, in Denver, Colo. Nelson explained that ragweed, which is the source for most early fall allergies, moves from north to south with the changing temperatures.
In fact, location matters even within a city. "It's certainly, in part, about where you put your pollen counter," said Dr. John Cohn, chief of the adult allergy section at Thomas Jefferson University in Philadelphia, Pa.
"I have patients who live on the Jersey shore, and their symptoms depend on whether there's a land breeze or a sea breeze," said Cohn.
Waldron says the goal is not to create an allergy sufferer exodus from the fall allergy capitals. Instead, she hopes allergy sufferers living in the cities on the list will take their home ranking as a call to action in September.
"Don't start packing yet. There are things you can do in your home town before you overturn your life," Waldron said.
Topping the AAFA's fall allergy capital list is Greensboro, N.C.
Greensboro -- once spelled Greensborough -- played a historic role the Revolutionary War, the Civil War and the 1800 textile boom in North Carolina.
Greensboro is also known for a large amount of green trees, although allergists say the trees aren't responsible for putting put Greensboro at the top of the AAFA Fall Allergy Capital List.
"Usually the fall is weeds and mold," said David Shulan, fellow of the American Academy of Asthma and Allergy Immunology, and a partner of the certified Allergy and Asthma Consultants in Albany, N.Y. Shulan says those pollinating trees strike in spring, not fall.
But sitting midway between North Carolina's coast and the Smoky Mountains to the West, the tree-filled Greensboro apparently also had the right climate to get a "worse than average" rating on ragweed pollen count.
The city also ranked worse than average on the number of allergists in town and on medication use. All total, Greensboro scored 100 on the AAFA scale. Not far behind, was another "green" city.
Tucked in the northwest corner of South Carolina, the small city of Greenville came in at a close second on the AAFA Fall Allergy Capital list with a score of 97.33.