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BACKGROUND:Urticaria is one of the most common dermatoses and affects 1525% of the population; chronic spontaneous urticaria occur in 1.8% of adults and in 0.13% of children. Second generation antihistamines are effective only in 4577% of patients. The next steps of treatment include increase antihistamines dose and their combination with omalizumab. AIM:To analyze own clinical experience and assess effectiveness of omalizumab in severe chronic spontaneous urticaria. MATERIALS AND METHODS:Effectiveness of biological treatment with omalizumab was analyzed in 14 patients with severe chronic spontaneous urticaria. RESULTS:The prescription of omalizumab in the basic therapy of patients with severe chronic spontaneous urticaria (CSU) allowed to reduce significantly the severity of clinical symptoms in 78.6% of patients, to abandon the use of systemicglucocorticosteroids and to achieve partial or complete control of the disease. It should be noted, that 28.5% of patients during the immunobiological therapy stopped taking second-generation antihistamines and the dosage was reduced to therapeutic in 35.7% of patients. CONCLUSION:Omalizumab is a highly effective in patients with severe chronic spontaneous urticaria.