Background: Very high levels of exposure to olive pollen in the south of Spain lead to differential allergen sensitization profiles.Therefore, new approaches to allergen standardization, diagnosis, and vaccination are necessary.Methods: Quantification of minor allergens in extracts, component-resolved patient diagnosis, and IgG4 individual allergen responses were used to evaluate new strategies in the management of olive pollen allergy.Results: Allergen variability observed between different olive cultivars can be used to identify suitable allergen sources that can be combined to yield consistent allergen extracts for diagnosis and immunotherapy.Component-resolved diagnosis can provide a better patient classification.IgG4 levels to major allergens increase significantly, whereas specific IgG4 to minor allergens does not seem to increase, at least during the early phases of immunotherapy.Conclusion: Patients exposed to extreme olive pollen levels display a different severity of allergy from those exposed to normal levels, which makes it necessary to follow a different clin. approach.The use of component-resolved diagnosis, better standardized allergen extracts, and new efficacy monitoring techniques will lead to a significant improvement in the management of olive allergy disease.