**11. Conclusion**

Therapeutics modulating IgE levels and activities provide an efficient and very tolerable add-on treatment for patients with antihistamine-refractory CU. With a strong evidence of the efficacy and safety, omalizumab is recommended as the first choice of treatment for CSU patients who still suffered from urticaria with up-dosing antihistamine treatment in recent international guidelines. However, as it is not disease-modifying agent, there is a subpopulation of CSU patients responding incompletely or never to omalizumab. Moreover, clinical evidence on chronic inducible urticaria (CIndU) and special populations, such as children and older patients is still not enough. Thus, a new anti-IgE treatment, ligelizumab is actively evaluated in the efficacy compared with both placebo and omalizumab. Further understandings on the pathogenesis of CU can lead to the development of new mechanism-based therapeutics for CU patients.
