Recent research has demonstrated that the successful use of nanometerscaled material, such as nanoparticles, as medicines is often challenged by the host immune system. Mechanisms of the innate immunity seem to provide a swift response to administration of particulate nanomedicines, which may clear or in other way incapacitate the function of these drugs. To rationalize, why and how, the innate immune system especially interacts with nanomedicines, this chapter points to the prominent role of polyvalent interactions by large, immunoactive proteins with the surfaces of nanoparticles. From addressing the thermodynamics and ultrastructural properties of these interactions, it is proposed that the nm-scaled ligand presentation and symmetry on such surfaces is a determinant in the binding of these proteins. Better control over nanomedicine ultrastructure is consequently likely to provide important ways of regulating the interactions, wanted or unwanted, with the innate immune system.