- 1 Background
- 2 Clinical Features
- 3 Differential Diagnosis
- 4 Evaluation
- 5 Management
- 6 Disposition
- 7 See Also
- 8 External Links
- 9 References
Pepper (oleoresin capsicum) spray is a commonly used riot-control and violence suppressive agent. It was first used by Federal Bureau of Investigation personnel in the US in 1973. The majority of the uses do not cause life threatening clinical effects. Commonly encountered effects include conjunctivitis, blepharospasm, and self induced corneal abrasions. Early decontamination minimizes the irritant effects.
Oleoresin capsicum (OC) is the main active ingredient and is extracted from the genus of the plant Capsicum annuum. The five capsaicinoids include:
Capsaicin and dihydrocapsaicin constitute 80-90% of pepper spray
Death Associated with Pepper Spray
- A Patient with excited delirium, placed in physical restraint (handcuffed in prone position) with a history of chronic bronchitis experienced asphyxia due to bronchospasm
- Painful burning sensation on skin
- Involuntary eye closure
- Decreased hand eye coordination
- Conjunctival injection
- Shortness of Breath
- Throat pain
- Blister chemical agents (Vesicants)
- Pulmonary chemical agents (Choking agents)
- Incendiary agents
- Cyanide chemical weapon agents (Blood agents)
- Prussic acid (AKA hydrogen cyanide, hydrocyanic acid, or formonitrile)
- Nerve Agents (organophosphates)
- Lacrimating or riot-control agents
- Pepper spray
Evaluation is focused on the irritated bodily area which is usually the eyes, throat, and skin, and lungs.
- Assess for corneal abrasions (approx 7% incidence) and blepharitis
- Patients may have decreased corneal sensation from 10 min after exposure to up to 1-2 hours and should be instructed to wear sunglasses or eyeware for protection.
- Patients with underlying respiratory disease such as COPD and asthma may experience shortness of breath or wheezing. To evaluation for Chemical pneumonitis a chest X-ray may be useful.
- Bronchoconstriction can be improved with inhaled beta-2 agonists such s albuterol
- Nasal and pharyngeal erythema and irritation will resolve quickly after decontamination
- Laryngospasm lasting up to 45 seconds has been described
- Patients may experience transient dermatitis and allodynia which will self resolve
Treatment should be consistent with any specific injuries that are identified. Injuries that require treatment are generally only:
- Evaluate and treat any corneal abrasions
- Patients with evidence of wheezing and bronchospasm may benefit from albuterol therapy
- Most pharyngitis and mucosal irritation will self resolve
- Cool water exposure to any irritated or erythematous areas may help reduce cutaneous pain.
Patients can generally be discharged. Only those with severe respiratory complaints may require a longer observation period in the Emergency Department
- Object of Interest: Pepper Spray. The New Yorker http://www.newyorker.com/tech/elements/object-of-interest-pepper-spray
- Yeung MF, William YM. Clinicopathological effects of pepper (oleoresin capsicum) spray. Hong Kong Med Journal 21(6). 2015
- Reilly CA, Crouch DJ, Yost GS, Fatah AA. Determination of capsaicin, dihydrocapsaicin, and nonivamide in selfdefense weapons by liquid chromatography–mass spectrometry and liquid chromatography–tandem mass spectrometry. J Chromatogr A 2001;912:259-67.
- Steffee CH et al. Oleoresin capsicum (pepper) spray and “in-custody deaths.” Am J Forensic Med Pathol 1995;16:185-92.
- Zollman TM, Bragg RM, Harrison DA. Clinical effects of oleoresin capsicum (pepper spray) on the human cornea and conjunctiva. Ophthalmology 2000;107:2186-9.
- Epstein RJ, Majmudar PA. Pepper spray in the eye. Ophthalmology 2001;108:1712-3.
- Smith CG, Stopford W. Health hazards of pepper spray. Available from: http://duketox.mc.duke.edu/pepper%20 spray.pdf. Accessed 1 Dec 2014.
- Kennedy WR, Vanhove GF, Lu SP, et al. A randomized, controlled, open-label study of the long-term effects of NGX-4010, a high-concentration capsaicin patch, on epidermal nerve fiber density and sensory function in healthy volunteers. J Pain 2010;11:579-87.