Should a patient who has hereditary alpha tryptasemia and has experienced multiple anaphylactoid reactions be tested for a venom allergy and started on VIT if positive?

No. Only individuals with a history of anaphylaxis following a Hymenoptera insect sting should be offered venom-specific IgE testing and/or skin testing. There are rare exceptions, including beekeepers with frequent large local reactions. The person from the question stem does not have a history of ...

HAT carriers *are* enriched in individuals with severe Hymenoptera anaphylaxis, and the Chollet and Akin paper, while important, is insufficiently powered to detect the presence or absence of clinical associations in HATS carriers vs controls in an unselected population.