FRESNO, Calif. - Every two weeks, Barbara Salcedo has to get an allergy shot.
"They've been helping me quite a bit," Salcedo said.
Salcedo says she started the shots five years ago, after she moved to Fresno from LA.
"More worser here I guess, than up there," Salcedo said.
Worse indeed. A report just out by the American Lung Association is grading the state of California by county air quality.
"California, in particularly the Central Valley are the most challenged parts of the nation in terms of air quality," Dr. Alex Sherriffs said.
The report ranks counties among categories when it comes to short term particle pollution.
Fresno-Madera ranked second worse, with Visalia-Porterville-Hanford in third, and Merced-Modesto coming in at the fourth worst.
"Highway 5, Highway 99, and diesel pollution is a very big component of the problem," Dr. Alex Sherriffs said.
But some valley air officials aren't happy with the study. A statement from the San Joaquin Valley Air Pollution Control District says "the 2012-14 information in the report, coinciding with the record drought, fails to acknowledge that last year was the cleanest on record for the valley."
But there was some good news. Both Fresno-Madera and Modesto-Merced had their lowest ever year-round particle levels.
"Air quality is much better. We have made tremendous progress over the last 15 to 20 years," Dr. Alex Sherriffs said.
But Dr. Sheriffs says more has to be done as the Central Valley continues to fight an uphill battle.
"Any pollution we do make, stays. So we have to work all the harder not to produce that pollution," Dr. Alex Sherriffs said.
He says drivers can make a difference in several ways.
"Be sure your next car, less pollution, better mileage than the car you've got now," Dr. Alex Sherriffs said.
They can also drive less, carpool and even use public transportation.
Any improvements would mean good news for Salcedo.
"It's quite bad here, you know, the allergies," Salcedo said.
For more information on the State of the Air report, visit http://www.lung.org/local-content/california/our-initiatives/state-of-the-air/2016/state-of-the-air-2016.html.