You might want to pick up some extra tissues.

CLEVELAND -- It's that time of year when you may find yourself wondering if you should be reaching for an Allegra or some cold medicine.

If you live in Northeast Ohio, there's a good chance you need allergy medicine.

Fall allergy season is upon us and that's bad news if you live in Akron or Cleveland.

The Asthma and Allergy Foundation of America ranked the 100 most challenging places to live with allergies and Akron and Cleveland made the list.

Akron ranked 19th overall and Cleveland ranked 34th.

Dayton made the top five, ranking at No. 5 while Toledo was ranked 10th. Columbus was ranked 29th.

The rankings are based on each city's pollen score, medicine utilization per patient and board-certified allergists per patient.

The foundation says more than 50 million Americans suffer from allergies, which account for $18 billion in annual cost.