The sandwich's design and packaging was created to reduce spillage for busy depression-era truck drivers in Pittsburgh's Strip District, allowing them to eat one-handed on the job instead of sitting down at a deli counter.

[6] In recent years, it has become tradition for players selected by the Pittsburgh Steelers in the NFL draft to visit the original Primanti Bros. location in the Strip District upon their arrival to the city.

[7][8] The chain expressed its support for the Pittsburgh Penguins during their back-to-back Stanley Cup championships in their 2015–16 and 2016–17 seasons, releasing two limited-time sandwiches in their honor.

In addition to other Pennsylvania locations, restaurants have been established in Florida, Ohio, West Virginia, Maryland, Michigan and Indiana.

[16] The restaurant was mentioned on the April 21, 2008, episode of The Daily Show with Jon Stewart in an interview with Senator Barack Obama.

As part of the settlement, the restaurant agreed to provide affected customers with a free menu item and a side dish or non-alcoholic drink.