Chronic urticaria (CU) is a common disease of unknown origin. Its impact on the quality of life is significant. Antibodies to high affinity receptors expressed on mast cells and basophiles (FcepsilonRI) are found in 30% of cases and may be associated with more severe and prolonged symptoms. A wide variety of disorders can be associated with CU. However, in the absence of suggestive signs or symptoms, an extensive workup rarely permits the diagnosis of an underlying pathology. In this case, the work up should be minimal. The newer generation oral anti-histamines represent the first line treatment. In the refractory cases, other drugs may be considered but few controlled studies support their use.