Introduction: Childhood allergies are increasing worldwide. Establishing dedicated paediatric allergy services in resourcelimited settings is challenging due to limitations in infrastructure, specialist training, and access to diagnostics. This abstract describes the early experience of a newly established service and its contribution to improving allergy care. Objectives: To describe the demographic and clinical characteristics of patients managed bythe paediatric allergy service at Colombo-North-Teaching-Hospital, Ragama, Sri Lanka, from 1 July 2024-31 January 2026. Methods: Retrospective analysis of the service database. Results: A total of 174 referrals were evaluated; 107 (61.5%) were male. Most patients were aged 5–10 years (39.7%). Suspected food allergy accounted for 69.54%(n=121) of referrals, andanaphylaxis was documented in 46.6%. Skin prick testing was performed in 151 patients. Confirmed food allergy was identified in 113 patients, with red meat, dairy , and gelatin as the most frequent allergens; shellfish, wheat and egg were less common. Eighteen were referred with suspected drugallergy . Most implicated drugs were paracetamo (n=5), NSAIDs (n=5), and beta-lactams (n=4). Seventeen oral graded drug challenges were performed (antibiotics n=9, paracetamol n=5, celecoxib n=3), confirming allergy in seven patients and enabling de-labelling in eleven. Two of three patients challenged with selective COX-2 inhibitors, reacted to celecoxib. Sixteen patients were diagnosed with chronic-spontaneous-urticaria, five with chronicinducible- urticaria and twelve with viral-induced or acute-spontaneous-urticaria. Conclusions: This early experience highlights a substantial unmet need for specialized paediatric allergy care and demonstrates the feasibility of delivering structured, guidelinebased evaluation and management within a tertiary care setting in Sri Lanka.