Summary: Chronic spontaneous urticaria (CSU) is characterized by wheals, pruritus and/or angioedema that recur for longer than 6 weeks. At present antihistamine drugs in up to quadruple of standard doses form the mainstay of CSU management. For antihistamine refractory CSU omalizumab – anti-IgE monoclonal antibody – is the recommended add-on treatment. However, there is a significant proportions of patients who either do not qualify for omalizumab treatment or fail to respond to it. The article summarizes the current mainstay of CSU management and present understanding of CSU pathophysiology as well as gives a general overview of new molecules under development indicated for urticaria.