The Asthma and Allergy Foundation of America (AAFA) recently published a report listing the best and worst cities in which to live if you have allergies. According,Knoxville Tennessee is the “Most challenging place to live with allergies” this year. The allergy capital of the country was selected based on three factors: number of allergists per capita, allergy medication sales per capita, and pollen scores.

For the second year in a row, Knoxville was rated the worst place to live if you have allergies. With high pollen scores and heavy usage of allergy medication, the city only has an average number of allergy specialists. Rounding out the top five cities were McAllen, Texas; Louisville, Kentucky; Jackson, Mississippi; and Wichita, Kansas.

According to the report, the best place to live if you have allergies is Portland, Oregon. Other great places include Boise City, Idaho; Daytona Beach, Florida; Denver, Colorado; and Salt Lake City, Utah.

It is thought that more than half of the entire U.S. population would test positive for at least one allergen. An allergic reaction occurs when the body’s immune system reacts negatively to something that most people’s immune systems consider harmless, resulting in a release of inflammatory proteins. Allergens include dust, pollen, foods, medications, and many other substances. Exposure to allergens can cause a range of symptoms, from sneezing and coughing to skin hives and rashes to an extreme, life-threatening reaction known as anaphylaxis.

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