Eighty-eight men and 88 women aged over 70 were presented with the coins in recognition of their work in the church and the community.
Hundreds of people lined the streets for the Queen's first visit to the cathedral.
Retired England footballer Jimmy Armfield, a lay canon at the cathedral, said the service was "very moving".
The Blackpool FC legend said the choir and organist had "done Blackburn proud".
"I'm sure the Queen would have been impressed," he said.
Each of the 176 recipients of the Maundy coin, one man and one woman for each year of the Queen's life, received a red purse of normal money and a white purse of silver Maundy coins.
Her Majesty, accompanied by the Duke of Edinburgh, went from the cathedral to a civic lunch at Ewood Park, Blackburn Rovers FC.
The Maundy money recipients went to a lunch at Blackburn's King George's Hall.
The Church of England Maundy tradition has its origins in the commandment to "love one another", issued by Jesus to his disciples after he had washed their feet on the day before Good Friday.
Members of the royal family have taken part in Maundy ceremonies since the 13th Century but coins were first used in the reign of Charles II.
Unlike normal coinage, which has been updated as the Queen has aged, the specially-minted coins carry the original portrait used on coins issued in 1953, the year of her coronation.