Nanoparticles are promising bioengineering platforms facilitating various consumer product formulations, including packaged food, electrical, biosensor and biomedical tools. The unique surface and physicochemical properties of amorphous nanosilica supports advanced nano-biomolecular applications for various manufacturing, biotechnology, and healthcare industries including cosmetics, packaging, implants, drug delivery systems and cancer diagnostics. The increased technological and economic benefits of amorphous nanosilica, raises concerns regarding their adverse biological effects on humans. The cellular mechanisms underlying amorphous nanosilica internalization, evasion of biological barriers, inadvertent nano-bio interactions and unexpected long term exposure effects must be taken into consideration from the diverse ecosystems and human safety aspects. Recent research studies reveal cytotoxic, inflammatory and immunomodulatory effects of amorphous nanosilica particles. Our review focuses on studies demonstrating hazardous impact of amorphous nanosilica/bio-systems interface on the cellular and biochemical processes. The review further seeks to evaluate amorphous nanosilica-induced cytotoxicity, innate immune responses, inflammation and immune related dysfunctions, and discuss open research questions related to the use of amorphous nanosilica in biomedicine. © 2020 Elsevier B.V.