Today the interest toward horse (Equus caballus) and donkey (Equus asinus) milk for human consumption is receiving a renewed attention because of its particular composition, hypoallergenicity, and nutraceutical properties. The realistic perspective of global use of this aliment in balanced diets, especially for infancy and geriatrics, poses the need for a more in depth knowledge on milk hygiene and on the health status of dairy animals, as a prerequisite of consumers' safety. The aim of this paper was to review the available literature on the health and hygiene parameters as well as on the potential microbiological hazards in horse and donkey milk and the risks related to their consumption. Both microbial contamination and somatic cell count are reasonably low in equine milk and also the presence of pathogens, like Escherichia coli O157, Salmonella spp., Campylobacter spp., Yersinia enterocolitica, Brucella spp., Mycobacterium spp., Bacillus cereus, Cronobacter sakazakii, Streptococcus equi subsp. zooepidemicus, Rhodococcus equi, Streptococcus dysgalactiae subsp. equisimilis, Clostridium difficile and Burkholderia mallei is low. However, in those regions of the world where the prevalence of Brucella spp. and Rhodococcus equi is high, the alimentary risks could increase. Similarly, in areas with higher incidence of immunocompromised people, the increased risks should be warned not only for pathogens but also for opportunistic microbiota.