If you live in the U.S. Midwest, buckle up for an intense allergy season … for the rest of your life.

Allergy season is becoming more intense across the country, lasting longer and with more pollen in the air. That’s bad news for the more than 60 million people in the United States who suffer from allergy-related sneezing, congestion and watery eyes. And just like brands of tissues, not all pollen-induced sneeze-fests are equal. Some places have it especially bad.

A report released Wednesday by the nonprofit Asthma and Allergy Foundation of America revealed last year’s U.S. “allergy capitals.” These were the most challenging places to live for those with pollen allergies. The rankings were based on pollen counts and took into account use of over-the-counter medication and the number of allergy physicians in the area.

The most difficult spot to live with allergies last year was Wichita, Texas, according to the report, followed by Dallas; Scranton, Pennsylvania; Oklahoma City; and Tulsa, Oklahoma, to round out the Top 5 locations. Seven cities in the Top 20 were in Florida.

“We’re seeing a lot more (pollen) in the South, which is what we are expecting because the southern cities have warmer winters. The plants grow and produce pollen for longer periods of time,” said Sanaz Eftekhari, the foundation’s vice president of research and an author of the report.

Some cities in the Northeast, such as Scranton, rank high because of their lack of over-the-counter medication use and number of allergists.

Some of the least challenging places to live with allergies last year, according to the report, were Buffalo, New York; Seattle; Cleveland, Ohio; Austin, Texas; Akron, Ohio; and Washington, D.C.

While some of these locations may have had a lot of pollen as well, they also had good access to medicine and specialists to manage symptoms, which are outlined by category in the report.

This year’s results largely fit in with regional trends seen around the past decade in the foundation’s pollen data, which is collected from various pollen sensors in the 100 most populated U.S. metropolitan areas. In data shared with the Washington Post, the cities that have consistently ranked in the past decade as having the highest pollen rankings in the country include: McAllen, Texas; Oklahoma City; Richmond, Virginia; San Antonio, Texas; and this year’s champ, Wichita.

“Wichita and Pennsylvania are some areas that have some extremely high levels,” said Landon Bunderson, a pollen researcher and CEO of Pollen Sense, a company that provided pollen data for this year’s Allergy Cities report. While many ground stations capture pollen grains and require someone to count them by hand (like Bunderson had to do for his PhD research), these devices automatically count grains each hour.

Plant ecologist William Anderegg, who was not involved in the report, said, “There is a lot of complexity and variation, particularly on the plant species and amount of vegetation, from city to city.” He said what determines the total amount of pollen in a city is a combination of the climate (such as the length of the growing season), plant species and amount of vegetation.

He said he would expect somewhat higher pollen levels in the Southeast, which his research found has been experiencing an increase in pollen because of climate change. He also noted large increases in Texas and the Midwest, which show high pollen data already.

Early start to a breathtaking 2023 season

This year’s allergy season is coming in early and in full force. Parts of the South and Northeast experienced record warmth in January and February. As a result, spring leaves appeared up to 20 days early in the eastern half of the country. The South experienced its earliest arrival of spring in four decades.

High pollen counts followed suit, according to Pollen Sense sensors. Atlanta saw “extremely high” pollen counts in March, according to Atlanta Allergy & Asthma’s pollen counting station. In D.C., tree pollen count reached a record high in February.

“Because we had a milder winter overall, we’ve been seeing an earlier pollen bloom,” said Anjeni Keswani, the physician and director of George Washington University’s Allergy, Asthma & Sinus Center in D.C. “Also, because of the milder winter, our mold spores did not significantly frost or freeze over, so we’re having a slightly earlier mold season as well.”

Keswani said she typically starts seeing pollen cases around March, but tree pollen levels increased as early as January and February. People started coming in around Valentine’s Day to treat their symptoms.

Although the report said D.C. fared well last year in terms of allergy risk, Keswani said she didn’t notice fewer patient visits. She said every spring pollen season in D.C. is significant, although D.C. typically doesn’t have a strong fall allergy season like other places.

She added that bustling cities, with a lot of traffic exhaust particles that mix in with the pollen, can spell even more bad news for people.

“If we breathe in sort of the air pollution of the particulate matter at the same time as the pollen, it actually can stimulate the immune system even more and create more symptoms,” Keswani said.

Bunderson’s company’s ground sensors have also measured “megaevents” of more than 15,000 pollen grains per cubic meter within one hour, which he said typically occur as a microburst on the front end of a storm. As pollen is released, our bodies can mistakenly identify the harmless substance as dangerous and produce chemicals to fight it, causing sneezing, wheezing, watery eyes and congestion.

“They’re happening when we have a big day for ripening and then we get an extreme wind event,” Bunderson said. “For someone who suffers from asthma, those (megaevents) are life-threatening,” he said.

It’s not particularly simple to forecast pollen plumes, and thus allergy intensity, far out – the plumes often depend on weather and wind conditions, which can worsen and spread pollen. At the moment, Pollen Sense can forecast three days into the future.

Right now, Keswani said, she’s trying to prevent and treat pollen allergies in people with immunization shots and medication.

“Pollen and pollen allergies are here to stay. With climate change, they’re actually potentially going to get worse,” she said.

How climate change worsens allergy season

Allergy sufferers know how this goes: Spring starts calling, and pollen begins falling. Blooms keep rolling, and our noses became swollen.

But recently, people are experiencing a more intense allergy season – and climate change is the reason.

Climate change affects allergy season in multiple ways. Many trees and plants require a certain amount of sustained warmth to trigger budding. Warmer winter temperatures allow them to accumulate the required amount of heat faster, causing them to start blooming earlier and for longer periods of time. The average temperature of winter, the fastest-warming season, has increased by more than 3 degrees Fahrenheit in the eastern United States since 1970.

Increased levels of carbon dioxide could also help supercharge photosynthesis, so trees and plants produce more pollen.

Ecologists, physicians and atmospheric scientists have already documented changes. Across North America, pollen season has lengthened by 20 days since 1990. Pollen concentrations have also increased by 21 percent over the past three decades. Data showed the largest changes in the Midwest and Texas.

Climate models show pollen season could worsen by the end of the century with high greenhouse gas emissions. The northern United States will experience more changes than the South because of larger changes in temperature, but it also depends on the tree species in each area.

The Northeast could experience more pollen production, as the blooming of some trees may move up. As a result, multiple tree species bloom all at once. The Southeast will probably experience the highest increase in pollen production because of prolific pollen-producing oak and cypress tree species, which are dominant in the region.

“On a larger scale, we really do support any efforts to mitigate climate change because, in the long term, that’s what’s leading to this increased concentration of pollen in the air,” Eftekhari said.