San Antonio has been named as one of five most challenging places in which to live with fall allergies in 2018.

A report released Monday by the Asthma and Allergy Foundation of America ranked San Antonio fourth among the 100 largest cities in the United States due to its high pollen count, rates of prescription medication use, and the number of allergy specialists located in the area.

In 2017, San Antonio ranked 16th on the list, said Angel Waldron, a consumer health advocate with the Asthma and Allergy Foundation, an education, advocacy, and research nonprofit that aims to improve the quality of life for people with asthma and allergies. The organization has published the Allergy Capitals report annually since 2003.

Waldron said during the fall, the South and the Midwest regions of the U.S. dominate the Allergy Capitals list, mostly due to large amounts of ragweed and its ability to easily grow and thrive in the area.

The No. 1 allergy capital for fall 2018 is McAllen, Texas, followed by Louisville, Kentucky, and Jackson, Mississippi. Coming in fifth behind San Antonio is Dayton, Ohio.

Local allergist Dr. Joe Diaz told the Rivard Report on Tuesday it is no surprise that San Antonio made a Top 5 list for places with high rates of allergies. “In San Antonio, patients suffer from allergies year-round because of the climate we have, and because there is always mold in the air. It’s a big allergy capital in the U.S.”

While ragweed is a main cause of fall allergy symptoms across the continental U.S., winter season is the most severe for many local allergy sufferers due to high rates of mountain cedar, Diaz said.

“Mountain cedar, which is really a local and Hill Country tree, pollinates extensively in the middle of the winter. Historically, the pollen counts peak around Christmas Day. There is no other pollen in the air at the time, and the northerly winds blowing in from the Hill Country help cause havoc in San Antonio.”

The best way to treat an allergy, Diaz said, is to avoid exposure by staying indoors during the early morning hours when plants pollinate the most and eliminating indoor allergens including dust mites and pet dander.

Study: San Antonio Ranks 4th in U.S. For Severe Fall Allergies