The activity of the phagocyte respiratory burst oxidase is regulated by complex and dynamic alterations in protein-protein interactions that result in the rapid assembly of an active multicomponent NADPH oxidase enzyme on the plasma membrane. While the enzymatic activity has been studied for the past 20 years, the past decade has seen remarkable progress in our understanding of the enzyme and its activation at the molecular level. This article describes the current state of knowledge, and proposes a model for the mechanism by which protein-protein interactions regulate enzyme activity in this system.