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Background Only 1% of patients with penicillin allergy are truly allergic but it remains the most common drug allergy reported. Studies show that direct oral challenge is a safe method to delabel low-risk patients using institutional screening stratification tools. There is no verified universal screening tool to perform this function, underscoring the need to address this clinical gap. This study aims to assess the efficacy of our institutional screening questionnaire at correctly stratifying penicillin allergy risk status and determine whether direct graded oral amoxicillin challenge can be safely used to delabel patients with low-risk penicillin allergy status. Figure 1Flow chart showing patient categorization based on penicillin allergy risk status and subsequent disposition following screening. Methods This was a pilot prospective study to verify penicillin allergy status among patients 3-18 years old in our institution from September 2021-March 2022. Patients were stratified using institutional screening questionnaire to no-risk, low-risk and high-risk penicillin allergy status. Low-risk patients underwent direct graded oral amoxicillin challenge using an institutional algorithm and delabeled based on their response to the testing. No-risk patients were delabeled without challenge testing. High-risk patients were referred to allergy. Results Ninety-two patients were identified with penicillin allergy. Forty (43.5%) of the 92 patients were screened using our institutional screening questionnaire. Of the 40 screened patients, 6 (15%) were identified as no-risk, 28 (70%) were identified as low-risk, and 6 (15%) were identified as high-risk. Twenty-four (86%) of the 28 low-risk patients were eligible for direct amoxicillin oral challenge. Seventeen (71%) of the 24 consented to the challenge testing but only 12 (70%) underwent direct amoxicillin oral challenge. Eleven (92%) of the 12 who underwent oral challenge were successfully delabeled. Five (83%) of the 6 no-risk patients were successfully delabeled. Three (50%) of 6 high-risk patients were referred to allergy. Overall, 16 (40%) of the 40 patients who were screened were successfully delabeled. Conclusion Our institutional risk stratification screening tool is effective at identifying penicillin allergy risk status and direct graded oral amoxicillin challenge is a safe initiative to delabel patients with low-risk penicillin allergy status. Disclosures All Authors: No reported disclosures.