Among the main beer components, fusel alcohols are important because of their influence on the flavor of the final product, and therefore on its quality. During the production process, these compounds are generated by yeasts through the metabolism of amino acids. The yeasts, fermentation conditions and wort composition affect fusel alcohols profiles and their concentrations. In this review, we provide detailed information about the enzymes involved in fusel alcohols formation and their regulation. Moreover, we describe how the type of yeast used, the fermentation temperature and the composition of carbohydrates and nitrogen source in wort, among other fermentation parameters, affect the biosynthesis of these alcohols. Knowing how fusel alcohol levels vary during beer production provides a relevant tool for brewers to achieve the desired characteristics in the final product and at the same time highlights the aspects still unknown to science.