Antibiotics are the most common class of medication prescribed to children. Penicillin and amoxicillin allergy labels are the primary reason pediatric patients are not treated with first-line antibiotic agents. Patients treated with alternative regimens are at higher risk of antimicrobial treatment failure and adverse drug reactions. Allergy labels are associated with prolonged hospitalizations, readmissions, and excess cost. Anywhere from 8-25% of patients carry a penicillin or amoxicillin allergy label. Up to 75% of these allergy labels are obtained by the age of 3 years. Penicillin-based allergies are confirmed in <3% of patients with reactions deemed low-risk for an IgE-mediated or other serious reaction. Challenging and removing the penicillin or amoxicillin allergy label (“de-labeling”) is recommended. Generally de-labeling is done by allergists-immunologists. Madigan Army Medical Center provides total care to a unique population of military dependents, including many pediatric patients with complex medical conditions. Allergy consults are currently deferred to the network due to staffing shortages and in a broader military context, access to allergists is limited in remote duty stations. Although allergy challenges can be performed by our colleagues in the civilian sector, there is not a reliable system in place to subsequently de-label within our electronic medical record (EMR). A growing body of evidence supports primary care de-labeling when the prior reaction is deemed low risk. Therefore, our team sought to establish a de-labeling process that may be performed within the Department of Pediatrics. Beginning in 2022, a multi-disciplinary team developed an evidence-based protocol to screen, challenge, and de-label pediatric patients with penicillin or amoxicillin allergy labels. The team used multiple modalities to advertise this project. When identified, eligible patients are referred for a virtual screening appointment. Only low risk reactions are challenged within the Pediatric Clinic; others are referred to Allergy/Immunology when indicated. All referrals that are deferred out of network for penicillin or amoxicillin allergy challenges are now recorded so results can be proactively obtained and rectified in our system. Thirty-three patients have been referred for allergy de-labeling. Of thirty patients who have been virtually screened to date, 27 were eligible for challenge including 19 (63%) with low-risk reactions that could be challenged by primary care. Twelve have been successfully challenged and cleared, and ten others are pending appointments. No adverse reactions have been reported. Our data suggests that the majority of these pediatric patients who are referred for penicillin and amoxicillin allergies are low risk for an IgE-mediated reaction and therefore can be safely challenged in primary care settings. This project meets a key objective of antibiotic stewardship while also modeling a de-labeling option that can be implemented in other resource-limited pediatric clinics.