Ochratoxin A (OTA) continues to grab global attention and concern for the hazard and impact that embody for both human and animals, based on its toxicity and occurrence. Despite OTA has been described in a myriad of foodstuffs, cereal and its derivatives remain the major contributors to OTA exposure. For that reason, a critical review on OTA occurrence reported by recent studies worldwide focusing on unprocessed and processed cereal foodstuffs is made in this work. Special attention is drawn to the major cereal derived products, namely flour, bread, breakfast cereals, baby/infant foods and the inherently involved technological food processing methods and its influence on the redistribution and chemical modification of OTA. The paper further examines the factors that influence the OTA content of cereal and its derived products, explicitly the different ecological niches of the ochratoxigenic mycobiota -Aspergillus spp. and Penicillium verrucosum, the agricultural practice involved, harvest procedures and storage conditions, the type of grain, and the nature and extent of technological processing as well as the ultimate stages of analytical quality level of the sampling and analysis of the suspected ingredients or foods.