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It’s a top ranking that Knoxville, Tenn., won’t be promoting any time soon: It’s No. 1 on the list of “most challenging” places to live if you have spring allergies. That’s according to the Asthma and Allergy Foundation of America’s 2010 ranking of 100 U.S. cities.

The city earned the dubious honor on the latest list of "The 100 Most Challenging Places to Live with Spring Allergies." Los Angeles, much maligned for its air pollution, ranked far better -- number 92 on the 2010 list. San Diego was 99, and Harrisburg, Pa., came in at number 100. (See full list at the end of this article)

What do the worst allergy cities have in common? What makes a city good for people with allergies?  Unfortunately, there are no easy answers. But allergy experts say there are key factors to look for.

How the 'Worst' Allergy Cities Are Computed

Unveiling the worst spring allergy cities in America has become an annual tradition. The lists are released by the Asthma and Allergy Foundation of America, in Washington, D.C., and many factors are plugged in to figure out which cities will get the dubious honor each year, says Mike Tringale, a spokesman for the foundation.

The foundation experts look at the most populated cities and take into account factors such as the region's pollen score (pollen count and other factors), along with the number of allergy medications prescribed and the number of board-certified allergists practicing there. Each city gets a score and then the list of 100 cities is drawn up.

More than half of the top 10 worst cities are Southern cities: Knoxville, Tenn.; Louisville, Ky., Chattanooga, Tenn.; Charlotte, N.C.; Greensboro, N.C.; and Jackson, Miss.

But Philadelphia; St Louis; Dayton, Ohio; and Wichita, Kan., are also in the top 10.

Why Are Some Cities Worse for Allergies Than Others?

"The fundamental issue with cities is the type of plant or grasses, trees or weeds that grow in the area," says Daniel Waggoner, MD, an allergist in Mystic, Conn., who is not affiliated with the list creation but is familiar with it.

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