Omalizumab(Xolair) has been approved for >12 year olds with chronic idiopathic urticaria(hives). These patients have failed multiple H1 antihistamines(ie. Atarax, Benadryl, Allegra, Claritin, Zyrtec and Xyzal) and H2 antihistamines(ie. Pepcid, Tagamet and Zantac) combinations. H1 antihistamines block ~80% of our itch receptors, where H2 block ~20%. When treatment failure occurs despite H1/H2 therapy we will attempt additional medications which include montelukast and aggressive systemic corticosteroids. Common triggers for hives includes underlying infections, foods , medication and stress. Labs are drawn to rule out other potential triggers. When all triggers are eliminated patients are classified as having idiopathic hives. This patients may then be eligible for Xolair therapy. After insurance prior authorization is approved our patients are started on 150-300mg subcutaneously every 4 weeks. Most patients show a clinical response within the 1ST 2-3 dosages.