The Allergy and Asthma Foundation of America (AAFA) grades the country’s cities every year based on the extent of difficulty to live there faced by people with allergies and respiratory conditions. These ratings are based on the medicinal usage for allergies and conditions like asthma, or they’re based on the pollen counts. Here’s a list of some of the worst cities to live in for people with allergies:

1. Jackson, Mississippi
Jackson was ranked right at the top for two consecutive years—this year and the last year. The high allergy score may be attributed to the rich foliage, high pollen content, and high humidity levels. A study by AAFA found that the allergy medicine usage and the pollen count in the city have been below average, but the city has a low number of allergists for every 10,000 patients. It’s best for people with allergies to cross this city off their lists if they’re planning to move.

2. Richmond, VA
AAFA ranked Virginia’s capital city, Richmond, high in its list of the worst cities to live in for people with allergies. It is predominantly because of the city’s triple threat: a higher number of people with allergies than average, a higher than normal allergy medicine use, and a high spring pollen count. So, Richmond is off the list of the “ideal cities to relocate to.”

3. Memphis, Tennessee
In this year’s report by the AAFA, Memphis is just six points behind Jackson. The city has seen a rise in pollen counts, which has become the prime cause of allergies. Memphis city enjoys warm weather, which is ideal for blooming flowers and trees. However, that brings about an increase in the pollen count as well, making it one of the worst places to live in for people with allergies.

4. Scranton, PA
The mining and railway history of Scranton is not unknown, and the dust and pollutant levels in the city are already very high due to this. Another prime cause of allergies among people in Scranton is the Birch trees, which grow along the city’s coal banks. The grass and tree pollen seasons overlap in this city, which means seasonal allergies are more intense and prolonged.

5. Syracuse, New York
Syracuse has been named one of the worst cities to live in for people with allergies this year. This is possibly because of El Nino, which leads to a warmer winter in the city, causing the allergy season to be longer. The city’s pollen score is higher than average, and the number of allergists per 10,000 patients and the patients using allergy medicine is average. Pollen is the prime cause of spring allergies among people living in Syracuse, and the heat and wind during spring aggravate pollen exposure and allergic symptoms.