Deoxynivalenol (DON, commonly known as vomitoxin) is one of the most common pollutants in grains and grain products, and it is a secondary metabolite produced by fungi such as Fusarium graminearum. DON is usually produced concurrently with its acetylated derivatives, including 3-acetyl-DON and 15-acetyl-DON, which show similar or even higher toxicity than DON, increasing the safety risk of grains and grain products. In this paper, we briefly describe the current status of research on the production, detection technologies and pollution status of DON acetylated derivatives. We also review recent progress in research on the toxicity and transformation of DON acetylated derivatives. Through this review, we hope to provide a theoretical foundation for future research on the degradation, prevention and control of DON acetylated derivatives in foods.