Acupuncture has long been used to treat urticaria in the Asian world. Acute urticaria can be easily and effectively treated with acupuncture. L111 (Quchi), Sp10 (Xuehai), Sp6 (Sanyinjiao), and S36 (Zusanli) are the 4 acupuncture points most commonly prescribed. Chronic urticaria is a challenge for medical therapy. There are at least 6 kinds of acupuncture methods developed to overcome this challenge. The combination of ordinary acupuncture and auricular acupuncture has been observed to be a highly effective cure of chronic urticaria. Acupuncture point injection with thiamine hydrochloride (vitamin B1) is also an effective treatment. However, results of these clinical observations have not been systematically confirmed for lack of a control group and the need for standard classification of urticaria. Although these observational results have clinical limitations, they do offer insight into an alternative to conventional treatment of urticaria. In the future, acupuncture or acupuncturelike techniques may provide an effective alternative for treatment of patients with urticaria, particularly those refractory to medication therapy.