This manuscript reviews the state-of-the-art regarding human biological monitoring (HBM)
of mycotoxins in plasma, serum and blood samples. After a comprehensive and systematic literature
review, with a focus on the last five years, several aspects were analyzed and summarized: (a) the
biomarkers analyzed and their encountered levels, (b) the analytical methodologies developed
and (c) the relationship between biomarker levels and some illnesses. In the literature reviewed,
aflatoxin B1-lysine (AFB1-lys) and ochratoxin A (OTA) in plasma and serum were the most widely
studied mycotoxin biomarkers for HBM. Regarding analytical methodologies, a clear increase in
the development of methods for the simultaneous determination of multiple mycotoxins has been
observed. For this purpose, the use of liquid chromatography (LC) methodologies, especially when
coupled with tandem mass spectrometry (MS/MS) or high resolution mass spectrometry (HRMS)
has grown. A high percentage of the samples analyzed for OTA or aflatoxin B1 (mostly as AFB1-lys)
in the reviewed papers were positive, demonstrating human exposure to mycotoxins. This review
confirms the importance of mycotoxin human biomonitoring and highlights the important challenges
that should be faced, such as the inclusion of other mycotoxins in HBM programs, the need to
increase knowledge of mycotoxin metabolism and toxicokinetics, and the need for reference materials
and new methodologies for treating samples. In addition, guidelines are required for analytical
method validation, as well as equations to establish the relationship between human fluid levels and
mycotoxin intake