Phosphocholine (PC) as a small haptenic molecule present on antigens of parasites can provoke various effects on immune cells leading to immunomodulation of the host's immune system. This immunomodulation not only allows long-term persistence but also prevents severe pathology due to down-regulation of cellular immune responses. Additionally, PC plays an important role for development and fertility of the parasites. To fully understand the mechanisms of immunomodulation the detailed knowledge of the biosynthesis of the PC-epitopes, their molecular structure and biological function has to be elucidated. The implication of parasite-specific transferases in the biosynthesis of the PC-epitopes and the sensitivity of parasites towards disruption of the choline metabolism offers new perspectives for the development of anti-parasitic drugs and therapies. Furthermore, the immunomodulation provoked by PC-epitopes preventing inflammatory reactions may be useful in the treatment of inflammatory diseases. This review summarizes the current knowledge on the biosynthesis of PC-epitopes, their structures and immunological implications.