Chronic urticaria is traditionally defined as recurrent hives for more than 6 weeks. In over 80% of the cases no exogenous allergen trigger or underlying systemic disease is identified, and hence, the condition is referred to as chronic idiopathic urticaria. Several theories have been suggested as the basis of pathogenesis, and because of the lack of evidence of underlying cause or trigger, treatment has been mostly directed toward symptomatic relief, but recently many advances in new therapeutic approaches have been reported. This review will focus on the recent advances in the pathogenesis and treatment of chronic urticaria.