This review of omalizumab use in chronic spontaneous urticaria (CSU) over a 9-year period in a rural setting identified that a 'complete response' to 3 months of omalizumab treatment was associated with an elevated IgE level, absence of other autoimmune diseases and older age, compared with a 'partial response'. Median CSU duration was 36 months prior to omalizumab. There is insufficient evidence to recommend routine IgE testing to predict omalizumab response as it is unlikely to change management.