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.