Patil AD, et al. - In this systematic review and meta‐analysis of randomized clinical trials (RCTs), researchers sought to assess the effectiveness of methotrexate as add on therapy to H1 antihistamine in difficult to treat chronic urticaria. “PubMed” and “Google Scholar” have been systematically searched to identify randomized clinical trials with methotrexate in patients with chronic urticaria who do not react to second-generation antihistamines. Two RCTs (n = 104) have been involved. According to findings, adding methotrexate to antihistamine in the treatment of difficult to treat urticaria did not have a major effect. The drawback of this meta-analysis is the use of only two randomized controlled trials.