Allergic diseases diagnosis involves demonstrating an adaptive immune response to allergens, often through immediate hypersensitivity reactions. In vitro tests, including allergen-specific IgE and Basophil Activation Test (BAT), are crucial for precision medicine approaches, enabling phenotype stratification and personalized treatment. BAT, though limited by technical requirements, shows promise for identifying severe allergic phenotypes. Serum baseline tryptase is a key marker for hereditary alpha-tryptasemia, associated with higher risk of severe reactions.