BackgroundOral food challenge tests are considered the gold standard for diagnosing food allergies; however, studies on their real-world implementation rates are limited. ObjectiveThe study aimed to investigate the proportion of school-aged children who underwent the oral food challenge test and to understand the motivations behind food elimination and utilization of various healthcare services. MethodsThe questionnaire-based survey for the parents of the students who submitted the "certificate for school life management (for allergic diseases)" was conducted across public elementary and junior high schools in Gifu Prefecture, Japan. ResultsThe study encompassed parents of 3457 children with food allergies who submitted the certificate. Approximately one-third of those eliminating the three major allergens—eggs (32.5%), milk (27.6%), and wheat (33.5%)—were diagnosed via oral food challenge tests, and approximately two-thirds were diagnosed using a combination of symptoms and blood tests, suggesting that majority of them were diagnosed appropriately. However, many children were diagnosed and eliminated foods based solely on blood tests without any symptoms of other allergens, such as buckwheat (55.8%), peanuts (29.2%), and tree nuts (21.2%), suggesting that there was likely unnecessary food elimination in these children. The elimination of buckwheat due to anxiety was associated with eliminating other foods for the same reason and eliminating two or more foods. ConclusionExamination of the real-world application of the proposed recommendations for the accurate diagnosis of food allergies suggests that close monitoring of the practical application should be conducted in each case to avoid unnecessary food elimination from children's diets.