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Publisher Summary This chapter explores the role of mass spectrometry in the identification of particular allergens and of the reaction the human body stages to the flowers and other parts of the elderberry tree. Nine patients with a long history in summer hay fever were tested for symptoms after inhalative and dietary contact with elderberry products. All of them reported rhinoconjunctivitis; four of them even exhibited asthmatic symptoms. As patients may be exposed to the allergens hailing from Sambucus nigra via the oral route—flowers and fruits have been used in plant remedies and food for centuries—it has been of special interest that one patient developed upper-airway obstruction when drinking elderberry juices. Four patients showed strong reactions after skin prick tests (SPT), medium response was observed in two cases, and negative results were received for three persons including the patient exhibiting airway obstruction. IgE serum levels measured by radioallergosorbent tests (RAST) also varied significantly. In some cases no serum IgE was detectable; in another case up to 4080 kU/L was measured. The fuzzy characteristic of the immuno-detected spots after 2D gel electrophoresis pointed out that the allergy elicitor may be just one protein, posttranslationally modified, such as by carbohydrate moieties, or that the immunological response results from highly homologous proteins with just minor variation in their polypeptide sequence.