Urticaria is a frequent dermatological skin disease characterized by the occurrence of transient pruritic wheals. The sensation of pruritus has been described to be stinging, tickling and burning in patients with chronic urticaria. Because of the unpredictable attacks of pruritus and swelling, urticaria strongly affects the quality of life in patients. In this review we focus on clinical characteristics, therapeutic options and new pathophysiological mechanisms including the novel T-cell cytokine IL-31 in pruritus of patients with chronic urticaria.