My allergies are terrible and Zyrtec just isn't cutting it this season. What are the recommended next-step medications or treatments a doctor would suggest when a standard antihistamine like cetirizine fails to provide relief?

Another step could be trying a different class of meds like adding a leukotriene receptor antagonist (montelukast). Some people just don’t respond well to certain antihistamines so rotating to loratadine or fexofenadine might help too. Combination therapy is very common during peak allergy seasons.

If symptoms are severe or year-round allergy testing and immunotherapy (allergy shots or sublingual tablets) may be suggested. This is more of a long-term fix rather than symptom control. Cleveland Clinic has a solid overview of treatment escalation here: https://health.clevelandclinic.org/allergy-medicine-not-working

This is actually pretty common. When cetirizine (Zyrtec) doesn’t work doctors often recommend switching to or adding a nasal corticosteroid spray like fluticasone or mometasone. These treat inflammation directly and are usually more effective for nasal congestion and post-nasal drip than antihistamines alone.