A new article published in Frontiers in Pediatrics reported that childhood urticaria is not rare, but its persistence is less frequent. In children, chronic spontaneous urticaria (CSU) is associated with comorbidities, including asthma, allergic rhinitis or atopic dermatitis, and many children with CSU have a family history of atopy. The therapeutic approach to CSU in children is the same as recommended by international guidelines for treatment of chronic urticaria in adults. In the European Union, according to the European Medicine Agency, omalizumab is the add-on drug of choice for the management of CSU in adult and adolescent patients, from 12 years of age onwards, who show inadequate response to H1 antihistamine therapy. In addition, in children (6 to <12 years of age), this drug is used as an adjunctive therapy of choice to enhance asthma control. In the management of children under 12 with urticaria, omalizumab can be administered only "off-label." The authors concluded that controlled studies are needed on the use of omalizumab in children younger than 12 years with CSU. Nevertheless, evidence suggests that an anti-IgE therapy could be a safe and effective alternative for the treatment of these young patients who have not responded to first-line treatment, but possibly using a personalized approach.