Urticaria is a common dermatosis characterized by spontaneous recurrent bouts of hives. A common belief is that the tedious search for an underlying cause of spontaneous urticaria is fruitless, and even when successful an appropriately dealt with, is not necessarily followed by complete resolution of symptoms. In contrast, urticaria has a great impact on patients' quality of life. These patients suffer considerable loss of energy, sleep disturbance, and emotional upset. Urticaria remains a big problem in term of etiology, pathogenetic mechanism, and pharmacologic treatment. Whereas textbooks and reviews on the topic of urticaria devote limited space to investigations and optional trial therapies for the entity, this article is devoted to the subject. A three-step template for the treatment of urticaria is offered which may prove helpful for you and your patients.