Evidence Level
Bromelain has been used medicinally since the 1950s and is approved in Germany as an anti-inflammatory for surgical swelling. Brien et al. (2004) systematically reviewed 10 studies and confirmed its efficacy for reducing post-surgical edema, particularly in dental and orthopedic procedures. For sinusitis, the Braun et al. (2005) trial demonstrated that adjunctive bromelain improved symptom resolution. A notable comparative trial by Akhtar et al. (2004) found bromelain comparable to diclofenac for knee OA with fewer GI side effects. Mechanistically, bromelain modulates prostaglandins (shifting PGE1:PGE2 ratio), degrades fibrin, and reduces bradykinin at inflammatory sites. It is absorbed intact through the GI tract, achieving measurable serum levels with systemic anti-inflammatory effects.