The safety status of lactic acid bacteria (LAB) and their capacity to survive the passage through the gastrointestinal tract (GI tract) have rendered them excellent candidates for the production of therapeutic proteins and their delivery in situ to the GI tract. During the past two decades, major health benefits of mucosally administered recombinant LAB have been successfully demonstrated, predominantly using animal models. However, the field has recently moved into the era of human clinical trials. In this review, we provide a timely update on the recent important advances made in this field, and outline the potential of recombinant LAB as therapeutic tools for their safe and efficient use in human health.