Hereditary alpha-tryptasemia (HaT) is an autosomal dominant genetic trait caused by increased copy numbers of the TPSAB1 gene and characterized by borderline to elevated basal serum tryptase (BST) levels. With a prevalence of 4–6% in the European population, HaT is relatively common but often underrecognized. We present two cases from the German Armed Forces: a 24-year-old female soldier with honeybee venom allergy and a 48-year-old male patient with multiple drug hypersensitivities. Both displayed persistently elevated BST (14–17 µg/L) and were genetically confirmed to carry TPSAB1 duplications. Systemic mastocytosis was excluded. For the soldier with venom allergy, venom immunotherapy was escalated to a lifelong high-dose regimen (200 µg maintenance instead of 100 µg) due to the increased risk of severe anaphylactic reactions. The second patient presentet multiple perioperative and allergological complications which were clarified by allergological testing, allowing targeted risk stratification. Both patients were equipped with personalized emergency kits (adrenaline auto-injector, antihistamines, corticosteroids) and received structured training. The military relevance of HaT is substantial. Soldiers are frequently exposed to insect stings during deployment and in case of necessary emergency treatment they often are in need of a wide spectrum of medications, including antibiotics and analgesics. Unrecognized HaT increases the risk of life-threatening intraoperative or emergency-related anaphylaxis. Early genetic testing avoids unnecessary invasive procedures such as bone marrow biopsies and allows for targeted preventive measures, thereby preserving operational readiness. HaT should be considered in all soldiers with unexplained elevated BST or recurrent hypersensitivity reactions. Adapted venom immunotherapy, lifelong patient education, and individualized perioperative management are critical to avoid emergencies in deployment medicine.