Frostbite is giving way to mild weather, and that leads to Texas’ most dreaded springtime trait: allergy season. According to a new report, San Antonio is among the most challenging cities in the U.S. for those suffering with seasonal allergies — and it’s likely to get worse in coming years.

In its annual Allergy Capitals report, the Asthma and Allergy Foundation of America identified the top 100 most allergy-inducing metropolitan areas in the country for 2021, with the Alamo City landing at No. 14 and earning a worse-than-average overall score.

As anyone who endures cedar fever can attest, Texas’ springtime allergens (which can appear out of thin air as early as December) are merciless. But according to the AAFA report, it’s actually fall allergens like ragweed that pack the most seasonal wallop in San Antonio, a detail that secures the city a spot at No. 12 on the report’s list of most allergic cities in the fall season versus its ranking as 16th worst city for spring allergens.

Nonprofit AAFA has produced the report since 2003 in an effort to help more than 50 million allergy sufferers in the U.S. prevent and manage their seasonal-allergy symptoms. The report is bases city rankings on three key factors: spring and fall seasonal pollen scores, use of over-the-counter allergy medications, and the number of allergy specialists in the area.

This year, the organization also considered how climate change, as well as the COVID-19 pandemic, affected those struggling with seasonal allergies. The effects of climate change are having far more impactful and long-ranging effects on allergies, with higher levels of carbon dioxide leading to increased levels of pollen in the air, according to the AAFA.

“Two notable parts of our 2021 report include the effect of COVID-19 and climate change on seasonal allergies,” says Kenneth Mendez, CEO and president of the AAFA. “In 2020, fewer people felt the impact of pollen allergies. This is likely due to COVID-19 restrictions with more people staying indoors. But climate change continues to cause longer and more severe allergy seasons. If we don’t slow down the cycle, pollen production will only intensify. This means symptoms could worsen as climate change continues to evolve.”

In a move likely to surprise any Texan battling allergies, the AAFA claims the most challenging place in the U.S. to live with allergies in 2021 is Scranton, Pennsylvania, followed by Richmond, Virginia, then Wichita, Kansas.

As for how the rest of the Lone Star State measures up for allergy sufferers, Texas border town McAllen lands at fourth on the AAFA list, with a worse-than-average overall score, and Dallas is ranked 19th, also with a worse-than-average overall score. No. 34 El Paso and No. 50 Houston both received an overall ranking of average.

Perhaps the most astonishing assertion the AAFA report makes involves Austin, which is just beginning to emerge from a record-breaking cedar season and is often proclaimed by stuffed-up locals to be a top allergy capital. But according to the report, Austin’s allergen challenges warrant a relatively low overall rank of 61 among the top 100 metropolitan areas in the country, with an overall score of average. Austin’s fall allergens place the Capital City at 50th on the report’s list of most allergic cities in the fall season and only 66th worse for spring allergens.

As most allergy-distressed Texans know, there is no cure for seasonal allergies. And experts at the AAFA say don’t beat around the bush when it comes prevention, recommending sufferers establish a good allergy-treatment plan based on their medical history, the results of allergy tests, and symptom severity.

“It’s important people with seasonal allergies prepare. They should try their best to reduce exposure to pollen,” says Dr. Mitchell Grayson, chair of the AAFA’s Medical Scientific Council. “Schedule an appointment with your allergist to work on a treatment plan together to help reduce allergy symptoms when prevention is not enough.”