Bromelain is a herbal medicine that is very commonly used in allopathy and naturopathy. Bromelain is the umbrella term for a group of different molecules, also called enzymes, that accelerate chemical reactions.
The name is derived from the plant family Bromeliaceae, in which bromelain can be found. The anti-inflammatory effect was already described in 1962 (Seligman B., 1962, Angiology).
Different bromelain enzymes can be extracted from pineapple fruit and pineapple stem (de Lencastre Novaes LC, et al., 2016, Biotechnol Prog.). Bromelain breaks down proteins such as hemoglobin, gelatin or fibrin into smaller components. It is discussed that the effect of bromelain cannot be explained by enzymatic activity alone. For example, bromelain suppresses the release of inflammatory messengers and inflammatory enzymes (IL-1β, IL-6, TNF-α, and PGE2, iNOS) (Bakare AO, Owoyele BV., 2021, Sci Rep.).
Bromelain inhibits the migration of specific cells of the immune system (neutrophil granulocytes) (Fitzhugh DJ, Shan S, et al., 2008, Clin Immunol) and activates phagocytes (Engwerda CR, Andrew D, et al., 2001, Cell Immunol.).
There is evidence that bromelain relieves pain two to three days after wisdom tooth surgery, although there is no evidence of a reduction in swelling (de A C Almeida R, de Sousa Lima FCM, et al, 2019, Int J Oral Maxillofac Surg.). Enzymes are dosed according to their total proteolytic activity in F.I.P. units. Typically, 500 to 1,000 F.I.P. units per day are recommended for up to seven days after surgery.
Side effects such as allergic reactions, a tendency to bleed, stomach problems and digestive disorders affect up to one percent of patients. Because of the risk of interaction, bromelain should not be taken in conjunction with aspirin. Because of its good tolerability, bromelain can be used as a supportive measure after plastic surgery operations, although safe and high-quality evidence of its effect is still lacking (Harris L, Darby P., 2020, Plast Reconstr Surg Glob Open.).