Pathophysiological biomarkers of chronic spontaneous urticaria (CSU) are emerging that may help to better target therapy for this disease. CSU is characterized by heterogeneity and the spontaneous onset of urticaria, which can be debilitating. There are currently no biomarkers available to predict disease course or response to treatment[5][2]. Treatment follows a three-line approach: nonsedating second-generation H1 antihistamines at standard or up to 4-fold doses, followed by biologic therapy with omalizumab[1][2][3][6]. Treatment success is assessed by UAS7 score, where continuation requires a decline of more than 11 points after three months[1]. Biomarkers such as D-dimers or substance P are considered promising but need further research[2]. CSU significantly reduces quality of life and affects the psychosocial status of the patient[6].