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Patients with chronic urticaria experience significant impairment, and require an effective treatment. Such treatment is preceded by a thorough diagnostic workup and measurement of disease activity, disease burden and disease control using well- established tools. Treatment is subsequently adjusted according to patient needs and therapeutic response, based on the tenet “as much as necessary, as little as possible” (in that order). Once disease control has been achieved, it is recommended that intermittent attempts at medication withdrawal be made in order to identify spontaneous disease remission. Chronic urticaria should be treated until sponta- neous remission occurs.