Evidence Level
Serrapeptase has been used clinically in Japan and Europe since the 1970s, primarily for post-surgical swelling and ENT conditions. The evidence base includes several small-to-moderate RCTs. Al-Khateeb and Nusair (2008) confirmed benefit for post-dental-surgery swelling. Mazzone et al. (1990) demonstrated significant improvements in chronic sinusitis symptoms. However, a 2017 systematic review (Bhagat et al.) noted that many studies are older, have small sample sizes, and variable methodology. The enzyme is absorbed intact from the GI tract when enteric-coated, reaching measurable serum levels. Its unique mechanism — degrading non-living protein debris while sparing living tissue — makes it theoretically useful for inflammation, but larger modern RCTs are needed to establish definitive efficacy.