The market for pollen allergy medications in Croatia is wide — from simple over-the-counter tablets to biologic therapies in hospitals. This article reviews the main medication groups, how they work, when to use them, and what typical side effects are.

Important: this is not medical advice or instructions for self-treatment. The specific choice of medication and dose depends on your medical history, other medications you take, and the type of allergy. Consult your family physician or pharmacist.

1. Antihistamines

The most commonly used group. They work by blocking histamine receptors (H1), so the symptoms caused by histamine (itching, sneezing, watery discharge) become much milder.

Second generation — over-the-counter choice

They cause less drowsiness than older generation and can be taken during the day. Available in Croatia:

  • cetirizine (Allergocyl, Xyzal and others)
  • levocetirizine — active isomer of cetirizine, less drowsy
  • loratadine (Pressing, Claritine and others)
  • desloratadine — active metabolite of loratadine
  • fexofenadine (Telfast and others)
  • bilastine (Bilaxten, Bilamed, Nixar)

Usually taken once daily. All are roughly equally effective, but individuals tolerate one better than another — it is worth trying a different one if the first choice does not help enough.

Side effects: dry mouth, mild drowsiness (cetirizine more than loratadine), fatigue. Do not mix with alcohol.

First generation — avoid for daytime use

  • chlorphenamine, diphenhydramine, promethazine

Cause strong drowsiness and reduce concentration — affect driving safety. Used only exceptionally (e.g., severe itching at night).

Nasal antihistamines

Azelastine is an antihistamine in the form of a nasal spray. Works quickly (15–30 minutes) and is used for sudden symptoms. Often found in combination sprays with corticosteroids.

2. Nasal corticosteroids — most effective for nasal congestion

The real "workhorse" of treatment for moderate to severe rhinitis. They reduce inflammation of the nasal mucosa and act on all symptoms of rhinitis, especially congestion.

Available in Croatia (mostly without prescription in smaller packs):

  • mometasone (Nasonex, Olynth Aqua and others)
  • fluticasone (Avamys, Flixonase)
  • budesonide (Rhinocort, Nasohabes)
  • beclomethasone

How to use them correctly

  • Take them regularly, not just "when it's bad". Full effect is achieved after 5–10 days of regular use.
  • Start a week or two before the season if you know when your allergy begins.
  • Direct the spray toward the outer wall of the nose, not toward the nasal septum (central part). The correct direction reduces the risk of bleeding.
  • Exhale gently before use, but do not sniff immediately after spraying.

Side effects: dry mucosa, occasional nosebleeds, rarely cause hoarseness. Safe for long-term use when used according to instructions.

Combination sprays

  • azelastine + fluticasone (Dymista) — combines the quick action of antihistamine and strong corticosteroid effect. Used in more severe forms.

3. Eye medications

Antihistamines and mast cell membrane stabilizers

  • Olopatadine — often first choice; works quickly and used 1–2x daily.
  • Ketotifen — similar effect.
  • Cromolyn — mast cell membrane stabilizer; must be taken preventively (start before the season).

Artificial tears

  • Help rinse pollen from the eye surface. No side effects, used as needed.

Corticosteroid drops

  • Use only short-term and only on doctor's recommendation due to the risk of elevated eye pressure and other side effects.

4. Saline solutions for nasal rinse

The simplest and safest measure that mechanically removes pollen from the nose. Use morning and evening during the season, but also before nasal sprays — the spray works better on a clean mucosa.

Available as physiological saline in sprays, but also as irrigation bottles (e.g., "neti pot"). Use only distilled or boiled and cooled water for irrigation, not tap water.

5. Decongestants

  • Pseudoephedrine (oral) and xylometazoline/oxymetazoline (nasal).

Shorten nasal congestion, but have important limitations:

  • Do not use nasal sprays for more than 5–7 days — longer use causes rebound effect (medication rhinitis) and dependence.
  • Avoid oral decongestants in pregnancy, high blood pressure, heart disease, and other conditions.
  • Can cause restlessness, heart palpitations, insomnia.

Best for one-off situations (flight, important meeting, exam), not for seasonal use.

6. Leukotriene antagonists

Montelukast (Singulair and generics) — tablet once daily, in the evening. Effect weaker than corticosteroids for rhinitis, but useful addition for asthma.

Important warning: American FDA and European agencies have issued a warning about possible psychiatric side effects (mood changes, anxiety, aggression, extremely rarely suicidal thoughts) — watch for these symptoms especially in children and young people. Stop taking and tell your doctor if they appear.

7. Specific immunotherapy (SIT)

The only therapy that changes the course of the disease, not just symptoms. Gradually "trains" the immune system to not react so strongly to the allergen.

  • Subcutaneous (SCIT) — injections at allergist's office: weekly during dose escalation phase, later monthly.
  • Sublingual (SLIT) — drops or tablets under the tongue, daily at home.

Treatment lasts 3–5 years and effect is maintained after completion. Effective for allergy to grasses, birch, ragweed, and dust mites.

Candidates are patients with:

  • clearly proven monoallergy or oligoallergy,
  • symptoms that significantly affect life,
  • limited response to over-the-counter medications.

8. Biologic medications (omalizumab and others)

Anti-IgE therapy for severe allergic asthma and chronic spontaneous urticaria. Expensive, applied as injection every 2–4 weeks. Available through hospital centers according to strict criteria.

How to create your own plan

  1. Mild symptoms — non-drowsy antihistamine (cetirizine/loratadine) + saline solution for nasal rinse.
  2. Moderate symptoms — antihistamine + nasal corticosteroid started early.
  3. Severe symptoms — combination spray (azelastine + fluticasone), eye drops, montelukast if needed.
  4. Unsatisfactory response — talk to allergist about immunotherapy.

Note

Medications have interactions with other drugs and are not all suitable for all patients (pregnancy, nursing, chronic diseases). Especially for new combinations, rely on the advice of your family physician or pharmacist.