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Chronic idiopathic urticaria (CIU) is one of the most frustrating disorders to treat in the field of dermatology. Diet therapy, antihistamines, and even immunosuppressive agents, including cyclosporin, methotrexate, and mycophenolate are often ineffective or poorly tolerated. CIU has a serious effect on patients' quality of life both physically and psychologically, with loss of energy, social isolation, and emotional distress similar to what is seen in patients with many other chronic cutaneous diseases. Of patients with CIU, 30% to 50% produce immunoglobulin (Ig) G antibodies against IgE or its high-affinity receptor. Omalizumab is a biologic agent approved for treatment of asthma; its effects are linked to blockade of the binding of IgE t…