Background: Tea is considered a healthy and harmless beverage. However, adverse reactions to several tea species, like chamomile or green tea, have been reported. Case report: We report a 55-year-old woman, who developed palmar and plantar itching, dyspnea, angioedema and dysphagia 10 min after drinking a tea prepared from a TCM granulate. Methods: Skin prick tests with common inhalant allergens, as well as with the tea and its individual components were performed. Total IgE, specific IgE and tryptase were measured. In addition, immunoblotting and CAP inhibition tests were done. Results: Skin prick tests showed moderately positive reactions to various storage mites and a strongly positive reaction to the TCM tea. Subsequent testing with all individual tea components was negative. Specific IgE to storage mites, mugwort and ragweed pollen was negative. Total IgE and tryptase were within normal limits. The immunoblot showed positive reactions to proteins between 15 and > 100 kDa in the TCM tea, but was negative to extracts from Tyrophagus, Lepidoglyphus, Acarus and Blomia, excluding contamination of the granulate with storage mite antigens. A recheck of the patients history revealed a former allergy to silk diagnosed 20 years ago. Subsequent assessment of specific IgE to wild silk by CAP was positive (5.1 kU/l). In a CAP inhibition assay, IgE binding to wild silk was inhibited by the TCM tea by 87%. Conclusion: In the present case, the anaphylactic reaction resulted from the presence of silk allergens in the TCM tea granulate, presumably due to infection of one of its raw materials by insect pests like Plodia interpunctella, Ephestia kuehniella or other related moth species and subsequent contamination of the plant material by silk proteins from pupal cocoons.