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Most urticaria sub types have a profound impact on patients’ quality of life and performance. Effective treatment is thus required in all cases where the avoidance of eliciting factors and the elimination of underlying causes is not feasible. In nearly all sub types histamine released by mast cells plays a predominant role. For symptomatic relief second generation non sedating histamine H1 receptor (H1R)‑antihistamines are, therefore, the first choice. However, double‑blind controlled studies have shown that dosages required to achieve complete protection from urticaria symptoms may exceed those recommended for other diseases, e.g., allergic rhinitis. Therefore, the current guidelines suggest increasing the dosage up to fourfold, whereas alternative treatments should be reserved as add‑on therapy for unresponsive patients.