Background: Chronic Spontaneous Urticaria (CSU) has been found to have a negative impact on all aspects of patients' lives -physical, mental, social and emotional. The ubiquitous and fascinating Giardia lamblia is primarily a gastrointestinal pathogen but it may present atypically (with or without gastroenterological manifestations). A link between Giardiasis and CSU was identified in the past. However, the possibility of this combination has been underappreciated in clinical practice, even in developed world, resulting in inordinate delay in reaching correct diagnosis and instituting targeted pharmacotherapy. Such a situation adds to the miseries of the patients, both mental anguish and physical suffering.