Introduction Inducible urticarias such as cholinergic or adrenergic urticaria (AU) can be challenging to control. Herein, we report an index case of AU successfully treated with omalizumab. Case Description A 17-year-old female with a history of Ehlers-Danlos syndrome, postural orthostatic tachycardia syndrome, and mast cell activation syndrome presented with diffuse pruritic evanescent welts with erythematous centers surrounded by white halos (Image 1) unresponsive to several therapies including a combination of high dose H1-antihistamines, H2-antihistamine, and leukotriene receptor antagonist in addition to a low dose beta-blocker. Due to the severity and frequency of the hives, omalizumab 300mg subcutaneous injections were initiated every 4 weeks resulting in complete resolution shortly after the first injection. She continues to maintain good control months later with no reported breakthrough episodes. Discussion AU is a rare form of urticaria first described in 1985, distinct from cholinergic urticaria. Although the exact mechanism of AU is unknown, it is believed to be provoked by a stress-induced concomitant release of epinephrine and norepinephrine. Diagnosis can be made by intracutaneous injection of adrenaline or noradrenaline, which produces the characteristic eruption. In this case the patient's diagnosis was based on clinical history and classic presentation of red papules surrounded by white halos. Although AU typically responds to trigger avoidance, H1-antihistamines and beta-blockers, when these treatments fail, additional therapeutic alternatives are limited. This is the first case demonstrating that AU can be successfully treated with omalizumab which should be considered as a treatment option if first line agents prove ineffective.