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Dietary changes expose consumers to risks from <i>Anisakis</i> larvae in seafood, leading to parasitic diseases and allergies. <i>Anisakis</i> is recognized by EFSA as a significant hazard, with potential oncogenic implications. Diagnostic advancements, like the Basophil Activation Test (BAT), enhance sensitivity and accuracy in identifying <i>Anisakis</i> sensitization, complementing traditional IgE tests. We conducted a cross-sectional study on patients with allergic symptoms from April 2021 to April 2023 at two outpatient clinics in western Sicily. Our goal was to assess the prevalence of <i>Anisakis</i>-related allergies and to identify risk profiles using specific <i>Anisakis</i> IgE and the BAT, especially in regions with high raw fish consumption. The study evaluated specific <i>Anisakis</i> IgE as a screening tool for <i>Anisakis</i> sensitization, using questionnaires, blood samples, and immuno-allergology analyses. <i>Anisakis</i>-specific IgE values were compared with the BAT results, with statistical analyses including Fisher’s exact test and logistic regression. The results showed an 18.5% seroprevalence of <i>Anisakis</i> IgE, while the BAT as a second-level test showed 4.63%, indicating the BAT’s superior specificity and accuracy. The study highlighted the importance of the BAT in diagnosing <i>Anisakis</i> sensitization, especially in cases of cross-reactivity with Ascaris and tropomyosin. The findings confirm the BAT’s exceptional specificity in identifying <i>Anisakis</i> sensitization and support using <i>Anisakis</i>-specific IgE for population-based risk profiling. The BAT can effectively serve as a confirmatory test.