Both spontaneous and inducible forms of chronic urticaria pose a significant economic burden and have an adverse effect on patients' quality of life. The international guidelines and US practice parameters for the diagnosis and management of chronic urticaria both recommend performing a thorough patient history and physical examination, conducting limited routine laboratory testing, and taking a stepwise approach to treatment. These documents differ in several areas, such as the order of diagnostic procedures and the treatment for patients non-responsive to standard dose H-1-antihistamines. Patients with chronic urticaria who visit a specialist have typically been treated with second-generation H-1-antihistamines-the recommended first-line treatments. The advantages and disadvantages of each treatment option should be taken into consideration when selecting therapies beyond H-1-antihistamines. Greater awareness of the international guidelines and US practice parameters will likely improve the quality of care for patients with chronic urticaria.