Allergy sufferers in the United States are no strangers to the challenge of seasonal pollen spikes, and new findings from the Asthma and Allergy Foundation of America (AAFA) provide insight into which cities are particularly difficult to live in for those affected. If you're prone to watery eyes, sneezing, or breathing difficulties, the 2026 report highlights some places to avoid or prepare for.

The top five worst cities for allergies

Topping the AAFA’s 2026 list is Boise, Idaho, a city where allergy sufferers are bracing for an especially heavy burden. San Diego, California, lands at number two, followed by Tulsa, Oklahoma, in third. Provo, Utah, holds the fourth position, while Rochester, New York, rounds out the list at number five.

These cities have become challenging environments for allergy sufferers due to a combination of factors like increased pollen production, local vegetation, and weather conditions that hinder pollen dispersion. Boise, for instance, experiences dry weather and strong winds that facilitate the spread of pollen, while San Diego is facing prolonged pollen seasons due to changes in climate patterns.

The Carolinas aren't spared

Though none of the Carolinian cities made the top five, several still feature prominently elsewhere in the rankings. Raleigh, North Carolina, ranked at number seven, has seen growing pollen problems likely driven by its expanding urban tree canopies. Meanwhile, Greenville, South Carolina, sits at number 10, and Winston-Salem, North Carolina, is ranked at 19. Charlotte, a major metropolitan area in North Carolina, is farther down the list at number 55, suggesting a comparatively easier environment for residents with allergies.

What makes these rankings significant

The AAFA report is a valuable tool for individuals managing allergies because it helps identify regions where the air quality may exacerbate symptoms. High allergy ranks are often driven by specific factors:

1. Pollen production: Plants native to or flourishing in these areas emit significant amounts of pollen. Common culprits include ragweed, grasses, and certain tree species like oaks and birches.
2. Weather impacts: Limited rainfall, heatwaves, and drought conditions can intensify pollen activity while preventing its breakdown. Conversely, high humidity can increase mold spores, presenting another issue for allergy sufferers.
3. Urban planning choices: Many cities with higher rankings have not optimized allergen reduction measures in landscaping, such as planting fewer male tree species—a notorious source of pollen.

In Raleigh's case, the rapid urbanization may have disrupted ecosystems in ways that amplify local pollen seasons. Similar conditions are likely contributing to Greenville’s ranking.

The broader connection to climate change

Climate change continues to amplify allergy burdens nationwide. Rising temperatures extending growing seasons allow plants to produce and release pollen for longer periods. This, paired with higher atmospheric CO2 levels, contributes to stronger allergen output from plants.

In the case of cities like Provo and Rochester, changing weather patterns likely exacerbate the effects. As temperatures hit new highs, non-native plants can thrive in previously inhospitable regions, adding unfamiliar and sometimes more aggressive allergens to the mix.

Managing allergies in high-burden cities

Living in a city on this list doesn’t mean fighting allergies alone. Several mitigative steps can help those dealing with symptoms:

• Air filtration: Invest in HEPA air filters for at-home and in-car use to lower indoor pollutant levels.
• Weather awareness: Monitor daily pollen forecasts, and plan outdoor activities during low-pollen times.
• Clean habits: Regular cleaning can stop pollen from settling indoors. Change clothes after being outside, and wash away residual allergens from skin and hair.
• Medication: Consult healthcare providers about antihistamines, nasal sprays, or allergy immunotherapy.

Why these rankings matter

The AAFA's rankings serve as a wake-up call for policymakers, residents, and urban planners in these problematic regions. It's not just about individual suffering. Allergies also contribute to reduced workplace productivity and increased healthcare costs. Awareness campaigns, improved urban tree planning, and accessible treatment resources could make a significant difference in these high-pollen areas.

For the nearly 81 million Americans who struggle with allergies annually, knowing where your city ranks can be an important step toward better management and preparation. While cities like Boise and San Diego present the toughest challenges in 2026, those considering moves or vacations may now look at the AAFA report as yet another useful guide to navigating allergy season.

With allergy prevalence only expected to grow, particularly in light of environmental changes, adapting to these evolving conditions remains more relevant than ever.