A 58-year-old man experienced generalized urticaria, orbital angioedema and dyspnea with ingestion of raw ginseng. The prick to prick skin test with raw ginseng showed a strong positive response and oral provocation with unprocessed raw freshginseng provoked facial flushing, generalized urticaria, dyspnea and bronchospasm, which were recovered by epinephrine injection. In the ELISA inhibition test, IgE binding to freshginseng was significantly inhibited by the fresh extracts of ginseng and birch. SDS-PAGE and immunoblot assays revealed an IgE-binding component, and common protein band was detected at 17 kDa (fresh ginseng-birch). This is the first case of freshginseng induced anaphylaxis, and our results suggest that freshginseng anaphylaxis is induced via an IgE-mediated mechanism and may have cross-reactivity with birch.