Spring allergy seasons are growing longer and more intense for many people. Noah Greenspan, PT, DPT, a board-certified clinical specialist in cardiovascular and pulmonary physical therapy and founder of Pulmonary Wellness Complex PT, attributes this to rising temperatures, higher humidity, and a greater prevalence of airborne allergens that together worsen air quality and extend exposure — with regional variation in impact.
The Asthma and Allergy Foundation of America (AAFA) compiled its 2026 list of the top 100 “allergy capitals” in the contiguous U.S. Rankings factor in tree, grass, and weed pollen levels, over-the-counter allergy medication use, and the number of allergy specialists in each metro area. Compared with prior years, the 2026 list includes more Western cities among the worst-ranked locations.
Top 20 worst U.S. cities for spring allergies (AAFA, 2026)
1. Boise, ID
2. San Diego, CA
3. Tulsa, OK
4. Provo, UT
5. Rochester, NY
6. Wichita, KS
7. Raleigh, NC
8. Ogden, UT
9. Spokane, WA
10. Greenville, SC
11. San Francisco, CA
12. Minneapolis, MN
13. Salt Lake City, UT
14. Richmond, VA
15. Colorado Springs, CO
16. Little Rock, AR
17. Toledo, OH
18. New Orleans, LA
19. Winston-Salem, NC
20. Lakeland, FL
See the full AAFA 2026 report for the complete rankings and methodology.
How to reduce exposure and manage symptoms
– Check local pollen forecasts and limit outdoor activity when counts are high. Early morning and windy days often bring higher pollen.
– Keep windows and sunroofs closed at home and in the car; run your HVAC with clean filters to help remove airborne allergens.
– Replace HVAC filters regularly, and use filters rated to capture fine particles if your system supports them.
– Take off shoes at the door, change clothes after being outdoors, and shower before bed to avoid bringing pollen indoors.
– Wear sunglasses outside to reduce pollen contact with your eyes and consider a wide-brimmed hat.
Medication and when to see a clinician
Over-the-counter antihistamines, nasal corticosteroid sprays, and eye drops can ease many symptoms. Nicolle Overstreet, DO, a family physician, recommends starting treatment early — often about two weeks before your usual symptom onset — so medications are working by the time pollen levels rise. If OTC remedies don’t provide sufficient relief, consult a healthcare professional about prescription options, allergy testing, or immunotherapy.
If you experience persistent or severe allergy-related inflammation, keep a symptom diary to identify triggers and seasonal patterns. That information can help clinicians tailor prevention and treatment plans, including targeted therapies when appropriate.