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<b>Background</b>: Food allergy is a leading cause of severe allergic reactions in children and often results in restrictive elimination diets. The oral food challenge (OFC) remains the diagnostic gold standard but is resource-intensive and carries a risk of adverse reactions. This study aimed to identify epidemiological, clinical, and laboratory predictors of OFC outcomes and reaction severity in children with suspected immediate-type food allergies. <b>Methods</b>: We conducted a retrospective review of 148 children who underwent hospital-based, open OFCs due to suspected immediate-type food reactions. Data on demographics, comorbidities, characteristics of the initial reaction, sensitisation profiles (specific IgE [sIgE], skin prick test [SPT]), and OFC outcomes were analysed. Reactions were graded using the Ring and Messmer scale. <b>Results</b>: OFC was positive in 44 of 148 children (29.7%). However, no clinical or laboratory parameters-including prior reaction severity and the magnitude of allergy test results-were associated with the severity of reactions during OFC. Comorbidities-specifically asthma, atopic dermatitis, and allergic rhinitis-were significantly associated with a positive OFC (<i>p</i> < 0.01), as were elevated sIgE levels and larger SPT wheal diameters (<i>p</i> < 0.01 for both). The optimal thresholds for predicting a positive OFC were 0.73 IU/mL for sIgE and 3.5 mm for SPT. <b>Conclusions</b>: Oral food challenge (OFC) remains essential for confirming food allergies in children. Given that the severity of reactions during OFCs cannot be reliably predicted and that low cut-off values of allergy tests were identified for predicting a positive OFC outcome, OFCs should be performed in a controlled and fully equipped medical setting, particularly in children with atopic comorbidities.