The Dutch guideline Chronic Urticaria aims to present a stepped-care model for the treatment of chronic spontaneous urticaria (CSU). In this manuscript omalizumab is discussed as a treatment option. Omalizumab is a humanized monoclonal antibody that selectively binds to immunoglobulin E (IgE). We have used the GRADE method to assess predefined outcome measures with regards to omalizumab, including disease activity, quality of life, adverse events, and complete and partial response. All 5 included studies were assessed as being of a 'low risk of bias'.The quality evidence was assessed as high.Treatment with omalizumab results in improvement of disease activity (including complete and partial response), improvement in quality of life, and an increase in angioedema free days. The proportion of patients suffering from adverse events after treatment with omalizumab does not differ significantly from placebo. Omalizumab is considered to be a good treatment option for CSU.