The Asthma and Allergy Foundation of America’s annual list of the spring allergy capitals has been released and for the second year in a row, Jackson, Mississippi, ranks first.

"Jackson is a beautiful city with a wide variety of trees and other pollen-producing plants that create higher than average pollen scores when compared to other municipalities around the country," Alex Burgess, spokesperson for AAFA, told weather.com. "This also results in higher than average medication usage by their citizens."

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Though the number one spot may have stayed the same from last year, the rest of the top 10 saw a shakeup. Syracuse, New York, climbed to third place on this year’s list after ranking 20th in 2015 . Providence, Rhode Island, and Buffalo, New York, also make appearances in this year’s top 10.

"We were surprised by Syracuse and Buffalo jumping into the top 10," Burgess said. "Spring pollen levels in both cities were much higher than those recorded in other major U.S. metropolitan areas, but Buffalo experienced a significant reduction in the number of certified allergists compared to last year, which may have influenced lower than expected medication utilization.

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Although there has been a trend over the last few decades of the spring allergy season inching up on the calendar, Dr. Clifford Bassett, medical director of Allergy and Asthma Care of New York and an ambassador for AAFA, told weather.com that the presence of El Niño this winter and the wet, mild winter weather much of the country saw can result in a stronger allergy season.

"In any year with an El Niño phenomenon, we expect certain areas of the country, particularly in the South, to be plagued by lots of rainfall and precipitation," Dr. Clifford Bassett said. "Each year it’s different. If you look at the aerobiology, you have a lot of different pollen areas. There’s a lot of cities [in the South] that are hit hard each year during the spring allergy season."

And Burgess agrees. "Certain parts of the country appear to be experiencing higher than average pollen counts while others have shown lower counts," which could be thanks to the presence of El Niño, he said. "Generally speaking, the United States has experienced a warmer than typical winter coupled with late winter precipitation that has created an earlier pollen season than typically seen. Pollen counts are on the rise around the country and individuals who experience seasonal allergies need to be proactive and meet with their allergists to prepare a plan to address their symptoms."

The AFAA compiles the annual city rankings using data on metro-area pollen counts, the availability of board-certified allergists in the region and rates of allergy medication use. The complete list and more information about the ranking are available at AllergyCapitals.com .