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.
Greenville is located in the lush foothills of the Blue Ridge Mountains. At that location, most residents would enjoy the moderate climate -- unless, the AAFA calculation proves correct. This year, Greenville jumped from it's 45th 2007 ranking.
While the spring rainfall and other weather patterns can change local allergies year by year, some allergists who study pollen counts were surprised by that high of a jump.
"You got to ask yourself, why? It's not like housing stocks," said Cohn. "Why would a city change? You'd think the flora and fauna wouldn't change."
Nelson had at least one explanation: while most of the weeds that contribute to what people call "fall' allergies actually bloom in late summer, an October in a warmer climate like Greenville resembles the temperatures of August in other parts of the country.
"If they (AAFA) really mean September by 'fall,' that may make more sense, because the ragweed is pollinating more down there," said Nelson. But in August, "the pollen counts in North Carolina and South would not even approach the Midwest counts."
Coming in at 3rd, up from 14th last year, is Little Rock, Ark.
Little Rock can lay claim on many historical movements. The city's area was inhabited by Native American tribes including the Choctaw and Cherokee and later occupied by French traders. In the 20th century the city became famous by the desegregation story of the Little Rock Nine, and the city was home to former President Bill Clinton.
"You're not going to be able to cure allergies or escape them," Waldron said. "If you know what your triggers are, and know how to avoid them, then you can live anywhere comfortably."
Part of knowing your triggers, Waldron said, is to go to an allergist and get tested and that's why AAFA included a ranking by a shortage of allergists.
Since Raleigh is known as the City of Oaks for its many oak trees, residents in the city may face tough allergy symptoms in the spring, as well as living in the AAFA's 4th most-challenging city during the fall.
"Even though we talk about rose fever in the spring, it's not rose," said Cohn. "We talk about hay fever in the fall, it's not hay."
Cohn explained that's because roses and other flowering plants actually don't release pollen into the air for reproduction, unlike oaks and maple trees.
"The flowering trees and grasses send out the pollen on the birds and the bees," said Cohn. "It's the less attractive plants that need to put lots of pollen in the air."
Less attractive to the bees, that is. But the City of Oaks attracts many others. Raleigh-Durham, and nearby Chapel Hill, welcome thousands of students each fall to the 10 colleges and universities in the area.
Jackson, Miss., namesake of Andrew Jackson, can lay claim to the great writer Eudora Welty and a tumultuous past from the civil war and through 1960s Civil Rights struggle. It also ranked 5th on the AAFA's list of challenging places to live with fall allergies.
With a relatively small population of 180,000 for a state capital, but seven large parks and a humid subtropical climate, at least some of its inhabitants are likely to run into allergies.
Waldron has some year-round advice for outdoor allergy sufferers: "Once you come home it's good to remove your shoes and clothes." Changing out of pollen-ridden clothes will ensure the offending irritant doesn't follow you around the house. Then, there's hair care.
"It acts like a mop while it's outside and then you bring it in," said Waldron. Allergy sufferers who don't wash their hair risk accumulating the pollen on their pillow case, making for horrible mornings. "It's a whole mess."
Located on the west side of the Appalachian foothills, Knoxville, Tenn., landed at 6th on the AAFA's list of fall allergy capitals.
Curiously, Knoxville's ragweed pollen score fell smack in the "average" rating of 300 grains per cubic meter air. That didn't impress Shulan.
"When I did my allergy fellowship in Iowa City, we got 5,000 (grains per cubic meter air)," said Shulan. "If you're ragwee- allergic, the Midwest is a bad place to be."
With those sorts of numbers, other allergists questioned why places like Knoxville would be on the list for fall allergies. Waldron said it depends on how one defines challenging.
"There are places that people know where the pollen is higher than other places," said Waldron. "But we wanted to do a more comprehensive overlook of the major metropolitan areas."
"There are other factors that contribute to it making a challenge to you," said Waldron. On example where Knoxville fell short, would be the number of allergists available. According to Waldron, a dearth of allergists across many cities has caused problems.
"In some areas, patients have a waiting time of 4-6 weeks to get help," said Waldron. "That's a month of misery."
Even though the city ranked 7th on this year's AAFA Fall Allergy Capitals, Grand Rapids can proudly boast one public health accomplishment.
Grand Rapids and other Michigan towns were the first to add fluoride to drinking water in 1945. The city also was became known for furniture, and was dubbed furniture city because it was a center for lumber and furniture manufacturing.
Although many may associate manufacturing towns with poor air quality, Cohn said nature and all its glorious ragweed is just as horrible of an irritant.
"I sort of joke in the office: if DuPont manufactured pollen, they'd be in trouble," said Cohn. "I see much more disease from natural products than I do for pollution."
"It sounds bad if you're saying bad things about Mother Nature," he joked.
With its cooler climate, Grand Rapids is likely to see an early peak to the fall ragweed season. Cohn said just to be careful driving by the highway where the plant often grows.
Wichita is known as the air capital of the world. The city claims that title because it is home to six aircraft manufacturing companies and the McConnell air force base.
Smack in the heart of the American plains, strong winds can carry ragweed in Wichita a far way. The area is also prone to severe thunderstorms and sometimes tornadoes.
But, residents who want to avoid pollen in the air can take several steps. First, watch the pollen count peaks during the day and avoid outdoor activities.
Allergists' recommendations of times to avoid going outdoors varied from early morning to mid-afternoon, but anytime in the evening should be safe.
Otherwise, "You might just have to keep your windows closed," said Shulan. With closed windows, and hypoallergenic air conditioners, Shulan estimates an indoor environment can cut down pollen count by 90 percent.
"We used to die in the Midwest years ago, air conditioning was quite helpful," said Shulan.
Although Oklahoma City still made the AAFA's top ten fall allergy capitals, the 9th ranking was an improvement of its 3rd place last year.
Both Oklahoma City and Wichita scored approximately 70 out of the 100 AAFA scale for fall allergies. Both cities are on the American plains (with their wind) and both cities took their name from neighboring Native American tribes.
Oklahoma comes from the Choctaw words 'okla,' meaning 'people,' and 'humma,' meaning 'red.' Literally translated, the name means 'red people.'
Residents of the low rolling hills, with shrubs and prairie grasses can take the same precautions staying indoors. But, medical treatments can do a world of good.
"There are some very good over-the-counter antihistamines that are very good," said Nelson. In addition to antihistamines, Nelson said allergy shots and nasal steroids can be even more effective.
According to the AAFA's calculations, students returning to University of Wisconsin-Madison may be in for a hay fever shock.
Madison ranked number 10 on the AAFA Fall allergy capitals, showing average pollen counts but high medication use and lower than average access to allergists.
Still, allergists don't believe pollen should dissuade anyone from going to the college, or city of their dreams. In addition to having four lakes to enjoy – Lake Mendota, Monona, Waubes and Kegonsa, Madison is consistently ranked in Money and Forbes magazines as one of the best, cheapest and safest places to live in the U.S.
"Back in the 19th century they used to publish lists of places where you could go to get away from ragweed," said Nelson, mostly in Main the Upper Peninsula of Michigan and the Rocky Mountains.
"You could go to all those places where there was nothing but pine trees and get away from the ragweed pollen," said Nelson. "To move now a days would be a rather extreme thing when there are really very effective ways to treat allergies,"