Spring has officially arrived, and with it come the itchy noses and watery eyes that allergy sufferers are used to experiencing at this time of year. As plants ring in the season by spraying tiny grains of pollen into the air, many people may be tempted to lock themselves inside with a box of tissues until fall—especially if they live in one of these cities.

Each year, the Asthma and Allergy Foundation of America (AAFA) compiles a list of the most challenging cities for people with allergies in the U.S. The ranking [PDF] is based on several factors, including local pollen count, use of allergy medication, and the number of allergists in the area. The American South is the most inhospitable region for people with hay fever this year, with McAllen, Texas; Louisville, Kentucky; and Jackson, Mississippi accounting for the top three slots. The only northern cities in the top 10—Providence, Rhode Island; Dayton, Ohio; and Syracuse, New York—fall in the eastern half of the country.

1. McAllen, Texas
2. Louisville, Kentucky
3. Jackson, Mississippi
4. Memphis, Tennessee
5. San Antonio, Texas
6. Providence, Rhode Island
7. Dayton, Ohio
8. Syracuse, New York
9. Oklahoma City, Oklahoma
10. Knoxville, Tennessee

For many people, seasonal nasal allergies are an uncomfortable annoyance, but for others they present bigger concerns. “Many don’t realize that allergies are a serious health condition,” Melanie Carver, vice president of community health and services for AAFA, said in press release. “Pollen seasons have gotten stronger and longer over the years because of climate change and this increases allergy rates and reduces quality of life for people with allergies."

According to one study, spring pollen has increased every year since 2000. In 2040, the pollen count could be up to 20,000 grains per cubic meter, compared to 8000 in the year 2000. If pollen is getting to your head this spring, follow these tips for keeping your allergies under control.