Olive Oil Sensitivity and desensitization: a non-IgE mediated mechanism

Introduction:The pungency of extra virgin olive oil (EVOO) is attributed to one of its phenolic compounds called oleocanthal (OC) and is mediated through the transient receptor channel potential cation channel ankyrin subtype 1 (TRPA1) expressed in the posterior oropharynx. EVOO also mimics the pharmacology of ibuprofen in that both agents cause a dose-dependent inhibition of cyclooxygenase enzymes COX-1 and COX-2. EVOO sensitivity has been described in the literature previously however EVOO desensitization has not. Herein we report the first case of successful EVOO desensitization using a novel EVOO desensitization protocol. Case description: A 25-year-old patient with medical history significant for aspirin sensitivity, exercise induce asthma and mixed vasomotor and allergic rhinitis presented with a history of facial and tongue pruritus, throat irritation, coughing and hives within minutes of olive oil consumption. Symptoms required diphenhydramine however several prior episodes required epinephrine. A series of food and drug challenges were entertained to establish the mechanism of EVOO sensitivity in this patient. Also a novel EVOO desensitization protocol was devised. Discussion:EVOO desensitization has not been reported previously in the literature and in this report we describe the first case of successful EVOO desensitization using a novel EVOO desensitization protocol. Furthermore the patient continues to be in a desensitized state 2 years after the procedure maintained with daily doses of 10 ml EVOO. Although the mechanism of her reaction is likely due to OC stimulation of TRPA1, the mechanism of desensitization and maintenance of the desensitized state is unclear and requires further study