March 20, 2012 -- The third time is said to be the charm. But it's doubtful the allergy sufferers in Knoxville find it charming that for a third consecutive year their East Tennessee city has earned the No. 1 spot on the list of the worst places to live with spring allergies.

Knoxville natives have had plenty to sneeze at each spring. In 2009, Tennessee’s third largest city placed second in this annual ranking of the 100 "most challenging places to live in the U.S. with spring allergies." And in 2008, the “Marble City" took the sixth spot in this listing, which is done twice a year -- in spring and fall -- by the Asthma and Allergy Foundation of America.

Several factors are considered when ranking each of the 100 largest metro areas, including pollen scores, number of allergy medicines used per patient, and the number of board-certified allergists per patient.

To top the list, Knoxville had "worse than average" pollen counts as well as utilization rates for allergy medications. But it received an "average" score on its number of allergy specialists available to treat patients with allergy-related symptoms, from runny noses and frequent sneezing to watery eyes and sinus congestion.

Here are the worst 10 cities for spring allergies:

    Knoxville, Tenn.
    McAllen, Texas
    Louisville, Ky.
    Jackson, Miss.
    Wichita, Kan.
    Oklahoma City, Okla.
    Chattanooga, Tenn.
    Memphis, Tenn.
    San Antonio, Texas
    Dayton, Ohio

For a complete listing of the top 100 allergy cities for spring, visit allergycapitals.com.

10 Signs Your Allergies Are Out of Control
Spring in Knoxville

The news that Knoxville has topped the list of most challenging places to live with spring allergies for a third time comes as no surprise to Allan Rosenbaum, MD, an ear, nose, and throat specialist in Knoxville who also treats allergy patients. "A lot has to do with the blessings of east Tennessee," he says.

"It's a beautiful place to live," explains Rosenbaum, "and few places in the U.S. have the variety of plant life." A great variety of trees are blooming right now in Knoxville, including its oaks, hickories, and some maples, he says.

And although spring begins today in terms of the calendar, the daffodils and tulips are already in full bloom. "It's very colorful," says Rosenbaum, and that also means an office filled with seasonal allergy patients, who are in sooner than usual from spring's early arrival in these parts.

It's not just the blooming trees and flowers that contribute to Knoxville's high pollen counts. The city is surrounded by mountains, located between the Smokies and the Cumberland Plateau, and it's also in the Tennessee Valley. That location causes pollen to get trapped in the region, where it can tickle the noses of Knoxville natives.

Rosenbaum says he is seeing more people coming in earlier for their allergy symptoms than last spring. He's also seen an increase in the number of people with seasonal allergies in middle age, who are dealing with hay fever for the first time in their lives.

For those with mild symptoms, he recommends a saline nasal rinse to reduce the pollen load and an over-the-counter allergy product. People with more severe symptoms should see their doctor for prescription medications.