We present Lightcurve Anomaly Identification and Similarity Search (LAISS), an automated pipeline to detect anomalous astrophysical transients in real-time data streams. We deploy our anomaly detection model on the nightly Zwicky Transient Facility (ZTF) Alert Stream via the ANTARES broker, identifying a manageable ∼1–5 candidates per night for expert vetting and coordinating follow-up observations. Our method leverages statistical light-curve and contextual host galaxy features within a random forest classifier, tagging transients of rare classes (spectroscopic anomalies), of uncommon host galaxy environments (contextual anomalies), and of peculiar or interaction-powered phenomena (behavioral anomalies). Moreover, we demonstrate the power of a low-latency (∼ms) approximate similarity search method to find transient analogs with similar light-curve evolution and host galaxy environments. We use analogs for data-driven discovery, characterization, (re)classification, and imputation in retrospective and real-time searches. To date, we have identified ∼50 previously known and previously missed rare transients from real-time and retrospective searches, including but not limited to superluminous supernovae (SLSNe), tidal disruption events, SNe IIn, SNe IIb, SNe I-CSM, SNe Ia-91bg-like, SNe Ib, SNe Ic, SNe Ic-BL, and M31 novae. Lastly, we report the discovery of 325 total transients, all observed between 2018 and 2021 and absent from public catalogs (∼1% of all ZTF Astronomical Transient reports to the Transient Name Server through 2021). These methods enable a systematic approach to finding the “needle in the haystack” in large-volume data streams. Because of its integration with the ANTARES broker, LAISS is built to detect exciting transients in Rubin data.