Introduction: Alpha-gal syndrome (AGS) is an IgE-mediated allergy , resulting from sensitization to galactose-? -1,3-galactose (alpha-gal), a carbohydrate found in non-primate mammals, introduced to humans primarily through tick bites. Symptoms vary from delayed onset urticaria to anaphylaxis. We describe three pediatric AGS cases presenting exclusively with delayedrespiratory symptoms, leading to diagnostic difficulty . Case 1: A three-year-old girl with episodic cough and wheezing for eight-months was managedas poorly controlled asthma. Her mother noted symptoms occurring on days the child consumed dairy , although no immediate-reactions were observed. Case 2: A four-year-old boy experienced recurrent wheezing and cough for one-year, withsymptoms occurring approximately two-hours after consuming red meat, dairy , or gelatine. Despite receiving optimal treatment, he experienced severe wheezing exacerbations. Case 3: An 18-month-old boy had six-months of cough, sneezing, runny and itchy nose,occurring a few hours after dairy intake. He was treated for asthma and allergic-rhinitis with limited improvement. All three children had a history of tick exposure, lacked other allergic manifestations, and initially tolerated dairy . Skin-prick-tests were positive for milk, beef, pork and gelatine. Alpha-galspecific IgE were 55.8 kUA/L, 36.6 kUA/L, and 0.16 kUA/L respectively , confirming the diagnosis of AGS. All three children markedly improved solely with a strict avoidance diet. Conclusion: AGS may present exclusively with delayed-respiratory symptoms, mimicking poorly controlled asthma/allergicrhinitis. Clinicians should consider AGS in children with delayed-onset respiratory symptoms that appear to be associated with ingestion of alpha-gal containing food, even in the absence of classical allergic features or previous tolerance of these foods.