Introduction: Alpha-gal syndrome (AGS) is an IgE-mediated-allergy resulting from sensitization to galactose-α-1,3-galactose following tick-exposure. Pediatric data from Sri Lanka remain limited. Objectives: To describe the clinical spectrum of AGS in children at a tertiary-pediatric-center, identify factors associated with anaphylaxis, and contributors to delayed diagnosis. Methods: We retrospectively analyzed children diagnosed with AGS between 1 August 2024-31 January 2026 at a tertiarypediatric- allergy-service. Diagnosis required compatible clinical history , alpha-gal–specific-IgE >0.1 kUA/L, positive skin-pricktesting, and symptom resolution with dietary-avoidance . Results: Sixty-four children were included; 60.9% were male, with a mean allergy onset age of 6.5±4.3years. Triggers included dairy (76.6%), red-meat (62.5%), gelatin (32.8%), MMR vaccine (6.3%), and fish eggs (1.5%); notably , 29.7% had never consumed red-meat. Anaphylaxis occurred in 73.4%. A family history of red-meat allergy (32.8%) and tick exposure (75%) were reported. Delayed reactions (>2 hours) were observed in 68.8%, and 84.4% reported inconsistent reactions to exposure. High alpha-gal–specific-IgE (≥3.5KUA/L) was present in 75%. Exclusive gastrointestinal (4.7%) and exclusive respiratory (6.25%) manifestations occurred following milk. Anaphylaxis risk was significantly associated with asthma and atopy (p=0.034, p=0.022) and higher IgE-levels (p=0.000). Children with coexisting milk-allergy experienced >five reactions prior to diagnosis (p=0.001), whereas those with isolated red-meat allergy were diagnosed earlier (≤2 reactions) (p=0.004). Avoidance of trigger/s eliminated recurrent reactions in all patients. Conclusion: High-alpha-gal–specific-IgE levels, asthma and atopy were associated with anaphylaxis risk. Children with isolated red-meat-allergy were diagnosed earlier than those with secondary-milk-allergy , highlighting the importance of evaluating patients for milk and gelatin; even in previously tolerant or inconsistently symptomatic patients.