The first West Virginia Italian Heritage Festival was held in downtown Clarksburg in 1979. The idea was proposed by the librarian at the Clarksburg Harrison Public Library, and a board of directors was formed, consisting mostly of prominent citizens of Italian descent. A parade, street concerts, authentic Italian food, cultural events (including art shows and opera), crafts, sports (bocce, morra, and golf), and the crowning of a festival queen were all part of the first Italian Heritage Festival and continued in later festivals.

Italians were the most numerous ethnic group to come to West Virginia during the massive immigration that accompanied the industrialization of the state. Clarksburg remains one of the centers of Italian-American population in West Virginia. The festival was designed to celebrate the state's Italian-American culture and highlight the contributions of the early immigrants. Each year the festival honors surviving immigrants by having them participate in a special parade. Prominent Italian-American entertainers and sports figures have been a part of the festival program, with past festivals having included Jerry Vale, Frankie Avalon, Joe DiMaggio, and Rocky Graziano. Recognition is given to the outstanding Italian-American man and woman of the year, who must be a native or resident West Virginian, and also to "honorary Italians." The West Virginia Italian Heritage Festival is held each Labor Day weekend beginning on Friday and concluding on Sunday.

In addition, the city of Wheeling hosts the Upper Ohio Valley Italian Heritage Festival annually in late July.