Introduction: Alpha-gal syndrome (AGS) is an IgE-mediated allergy resulting from sensitization to galactose-alpha-1,3galactose. Although classically associated with delayedurticaria/ anaphylaxis following red meat ingestion, AGS can present with diverse and atypicalpresentations. We report six patients with atypical-manifestations. Case presentations: Case-1: A four-year-old boy with recurrent wheeze and cough for oneyear was treated as poorlycontrolled-asthma. Symptoms showed an inconsistent association with dairy and red meat consumption, without cutaneous manifestations. Case-2: An 11-year-old boy with recurrent abdominal pain and altered bowel habits for oneyear was managed as irritablebowel-syndrome; symptoms frequently followed dairy ingestion. Case-3: An eight-year-old boy experienced brief episodes of urticaria for four-months and wastreated as chronic-spontaneousurticaria with poor response to standard treatment. Case-4: A six-year-old boy developed anaphylaxis three-hours after ingesting gummy bears while playing. Case-5: An 18-year-old girl presented with anaphylaxis four-hours following ingestion of fish roe; further history revealed delayed abdominal pain after dairy consumption. Case-6: An 18-year-old girl was referred following 19 episodes of anaphylaxis since age of sixyears, with no identifiable trigger. All patients recalled a history of tick bites. Delayed-onset of symptoms and inconsistent reactions to alpha-gal–containing foods were noted. The diagnosis of AGS was confirmed by skin prick testing and specific IgE to alpha-gal. Elimination of the implicated food allergens led to complete-resolution in all cases. Conclusion: This case-series illustrates the broad and atypical spectrum of paediatric AGS,including respiratory , gastrointestinal, and unexplained anaphylactic presentations. Recognition of non-classical manifestations and unusual dietary triggers are key to early diagnosis, prevention of recurrent anaphylaxis and improve outcome.