Treatment of chronic urticaria presents a challenge to both practitioner and patient. Traditional H₁ antagonists with good efficacy but substantial side effects are being supplanted in many cases by nonsedating H₁ antagonists such as terfenadine and astemizole. Antidepressant medications and combinations of H₁ and H₂ antagonists offer improved results for selected patients. Further development and investigation of mast cell stabilizers and inhibitors of urticaria mediators other than histamine hold promise. A better understanding of the underlying pathogenesis remains the greatest hope of formulating rational and effective therapy.