Introduction: Alpha-gal syndrome (AGS) is a unique, delayed-type food allergy triggered by galactose-α-1,3-galactose, a carbohydrate found in mammalian meat and related products. Objectives: This study aimed to describe the clinical profiles, sensitization patterns, and basophil reactivity of children diagnosed with AGS at a specialized allergy clinic in Sri Lanka between 2023 and 2025. Methods: 78 children (42 males) with a suspected history of alpha-gal syndrome (AGS) were recruited. Demographic data were collected along with a comprehensive clinical evaluation. All participants underwent skin prick testing (beef, pork, mutton, gelatin, and cow’s milk) and measurement of serum alpha-gal–specific IgE using ImmunoCAP. Basophil Activation Testing (BAT) was performed in a subset (n=8) to assess basophil reactivity to alpha-gal, beef, pork, mutton, and cow’s milk allergens. Results: The median age of the cohort was 11 years (IQR: 6 months–18 years), and the age of onset of AGS was 5 years (IQR: 3-9 years) Anaphylaxis was documented in 48 patients (61.54%; 95% CI: 50- 71.6). The median time interval between the exposure and symptom onset was 2-6 hours. A positive family history of mammalian meat allergy was a significant risk factor for AGS (p < 0.0001; OR = 14.2, 95% CI: 3.9–30.1). In the subset undergoing BAT, marked basophil reactivity to alpha-gal and other allergens were observed, with activation profiles indicating a primed basophil phenotype. Conclusion: AGS in Sri Lankan children presents with a high burden of anaphylaxis and delayed reactions, and BAT functional evidence of sensitization, supporting improved diagnostic accuracy .