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Achanta S, Chintagari NR, Balakrishna S, Liu B, Jordt SE. Pharmacologic Inhibition of Transient Receptor Potential Ion Channel Ankyrin 1 Counteracts 2-Chlorobenzalmalononitrile Tear Gas Agent-Induced Cutaneous Injuries. J Pharmacol Exp Ther 2024; 388:613-623. [PMID: 38050077 PMCID: PMC10801748 DOI: 10.1124/jpet.123.001666] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/27/2023] [Accepted: 10/31/2023] [Indexed: 12/06/2023] Open
Abstract
Deployment of the tear gas agent 2-chlorobenzalmalononitrile (CS) for riot control has significantly increased in recent years. The effects of CS have been believed to be transient and benign. However, CS induces severe pain, blepharospasm, lachrymation, airway obstruction, and skin blisters. Frequent injuries and hospitalizations have been reported after exposure. We have identified the sensory neuronal ion channel, transient receptor potential ankyrin 1 (TRPA1), as a key CS target resulting in acute irritation and pain and also as a mediator of neurogenic inflammation. Here, we examined the effects of pharmacologic TRPA1 inhibition on CS-induced cutaneous injury. We modeled CS-induced cutaneous injury by applying 10 μl CS agent [200 mM in dimethyl sulfoxide (DMSO)] to each side of the right ears of 8- to 9-week-old C57BL/6 male mice, whereas left ears were applied with solvent only (DMSO). The TRPA1 inhibitor HC-030031 or A-967079 was administered after CS exposure. CS exposure induced strong tissue swelling, plasma extravasation, and a dramatic increase in inflammatory cytokine levels in the mouse ear skin. We also showed that the effects of CS were not transient but caused persistent skin injuries. These injury parameters were reduced with TRPA1 inhibitor treatment. Further, we tested the pharmacologic activity of advanced TRPA1 antagonists in vitro. Our findings showed that TRPA1 is a crucial mediator of CS-induced nociception and tissue injury and that TRPA1 inhibitors are effective countermeasures that reduce key injury parameters when administered after exposure. Additional therapeutic efficacy studies with advanced TRPA1 antagonists and decontamination strategies are warranted. SIGNIFICANCE STATEMENT: 2-Chlorobenzalmalononitrile (CS) tear gas agent has been deployed as a crowd dispersion chemical agent in recent times. Exposure to CS tear gas agents has been believed to cause transient acute toxic effects that are minimal at most. Here we found that CS tear gas exposure causes both acute and persistent skin injuries and that treatment with transient receptor potential ion channel ankyrin 1 (TRPA1) antagonists ameliorated skin injuries.
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Affiliation(s)
- Satyanarayana Achanta
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Narendranath Reddy Chintagari
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Shrilatha Balakrishna
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Boyi Liu
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
| | - Sven-Eric Jordt
- Center for Translational Pain Medicine, Department of Anesthesiology (S.A., B.L., S.-E.J.) and Department of Pharmacology and Cancer Biology (S.-E.J.), Duke University School of Medicine, Durham, North Carolina; Department of Pharmacology, Yale University School of Medicine, New Haven, Connecticut (N.R.C., S.B.); and Integrated Toxicology and Environmental Health Program (ITEHP), Nicholas School of the Environment, Duke University, Durham, North Carolina (S.-E.J.)
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Quiroga-Garza ME, Ruiz-Lozano RE, Azar NS, Mousa HM, Komai S, Sevilla-Llorca JL, Perez VL. Noxious effects of riot control agents on the ocular surface: Pathogenic mechanisms and management. FRONTIERS IN TOXICOLOGY 2023; 5:1118731. [PMID: 36733462 PMCID: PMC9887149 DOI: 10.3389/ftox.2023.1118731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 01/04/2023] [Indexed: 01/18/2023] Open
Abstract
Riot Control Agents (RCAs) are chemical compounds used by law enforcement agencies to quell violent demonstrations as an alternative to lethal force and as part of police/military training. They are also known as tear gases because of the hallmark ocular irritation and lacrimation they cause. The most common RCAs include oleoresin capsicum (contained in Mace and pepper spray), chlorobenzylidene malononitrile, dibenzoxazepine, and chloroacetophenone (previously the main content of Mace); some of which have been in use for decades. Their immediate incapacitating effects are mediated through polymodal afferent fibers innervating the corneal surface, inducing the release of peptides that cause neurogenic inflammation. Although previously thought to have only transient effects on exposed patients more severe complications such as corneal stromal opacities, corneal neovascularization, neurotrophic keratopathy, conjunctival necrosis, and pseudopterygium can occur. Concerningly, the lack of research and specific therapies restrict the current management to decontamination and symptom-tailored support. This manuscript will provide an overview of the toxic mechanisms of RCAs, their clinical manifestations, and current therapy after exposure to tear gases.
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Affiliation(s)
- Manuel E. Quiroga-Garza
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Raul E. Ruiz-Lozano
- Tecnologico de Monterrey, School of Medicine and Health Sciences, Institute of Ophthalmology and Visual Sciences, Monterrey, Mexico
| | - Nadim S. Azar
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Hazem M. Mousa
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Seitaro Komai
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Jose L. Sevilla-Llorca
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States
| | - Victor L. Perez
- Department of Ophthalmology, Duke University Medical Center, Durham, NC, United States,Foster Eye Center for Ocular Immunology, Duke Eye Center, Durham, NC, United States,*Correspondence: Victor L. Perez,
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Forrester MB, Holloway C. Characteristics of pepper spray-related injuries reported to the National Electronic Injury Surveillance System during 2000-2020. Clin Toxicol (Phila) 2021; 60:348-355. [PMID: 34402691 DOI: 10.1080/15563650.2021.1966028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Exposure to pepper spray may result in adverse dermal, ocular, and inhalation effects. Furthermore, pepper spray, including the more potent bear spray, was used by both law enforcement and protesters in 2020 in the protests related to racial justice and COVID-19 pandemic restrictions. The objective of this study was to characterize pepper spray-related injuries treated at United States (US) emergency departments (EDs). METHODS Data were obtained from the National Electronic Injury Surveillance System, a database of consumer product-related injuries collected from approximately 100 US hospital EDs. Pepper spray-related injuries reported during 2000-2020 were identified by reviewing all records that included the letter groups "pep" or "bear" in the Narrative field and "spray" in the Narrative field or Product code 1619 in the Product_1, Product_2, or Product_3 fields. RESULTS A total of 1112 pepper spray-related injuries were identified, resulting in a national estimate of 34,582 pepper spray-related injuries, of which 43.4% were reported during 2014-2020. Of the estimated exposures, the age distribution was 14.5% 0-5 years, 18.5% 6-12 years, 18.2% 13-19 years, 19.6% 20-29 years, 11.8% 30-39 years, 9.1% 40-49 years, and 8.3% 50 years or older; 55.9% of the patients were male. The exposure route was 52.0% ocular, 25.7% dermal, 13.6% inhalation, 2.9% ingestion/oral, and 14.1% unknown. CONCLUSIONS Patients with pepper spray-related injuries tended to be older children and young adults, and the majority of patients were male. The route of exposure of most of the injuries was ocular.
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Affiliation(s)
| | - Cristina Holloway
- North Texas Poison Center, Parkland Health & Hospital System, Dallas, TX, USA
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Calumpang CLF, Saigo T, Watanabe M, Tohge T. Cross-Species Comparison of Fruit-Metabolomics to Elucidate Metabolic Regulation of Fruit Polyphenolics Among Solanaceous Crops. Metabolites 2020; 10:E209. [PMID: 32438728 PMCID: PMC7281770 DOI: 10.3390/metabo10050209] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/03/2020] [Accepted: 05/14/2020] [Indexed: 11/24/2022] Open
Abstract
Many solanaceous crops are an important part of the human daily diet. Fruit polyphenolics are plant specialized metabolites that are recognized for their human health benefits and their defensive role against plant abiotic and biotic stressors. Flavonoids and chlorogenates are the major polyphenolic compounds found in solanaceous fruits that vary in quantity, physiological function, and structural diversity among and within plant species. Despite their biological significance, the elucidation of metabolic shifts of polyphenols during fruit ripening in different fruit tissues, has not yet been well-characterized in solanaceous crops, especially at a cross-species and cross-cultivar level. Here, we performed a cross-species comparison of fruit-metabolomics to elucidate the metabolic regulation of fruit polyphenolics from three representative crops of Solanaceae (tomato, eggplant, and pepper), and a cross-cultivar comparison among different pepper cultivars (Capsicum annuum cv.) using liquid chromatography-mass spectrometry (LC-MS). We observed a metabolic trade-off between hydroxycinnamates and flavonoids in pungent pepper and anthocyanin-type pepper cultivars and identified metabolic signatures of fruit polyphenolics in each species from each different tissue-type and fruit ripening stage. Our results provide additional information for metabolomics-assisted crop improvement of solanaceous fruits towards their improved nutritive properties and enhanced stress tolerance.
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Affiliation(s)
| | | | | | - Takayuki Tohge
- Graduate School of Science and Technology, Nara Institute of Science and Technology (NAIST), Ikoma, Nara 630-0192, Japan; (C.L.F.C.); (T.S.); (M.W.)
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Yenigun O, Thanassi M. Capsaicin: An Uncommon Exposure and Unusual Treatment. Clin Pract Cases Emerg Med 2019; 3:219-221. [PMID: 31403095 PMCID: PMC6682244 DOI: 10.5811/cpcem.2019.3.41231] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 03/11/2019] [Accepted: 03/28/2019] [Indexed: 11/29/2022] Open
Abstract
Capsaicin, the active component of chili peppers, is an alkaloid that causes tissue irritation and burning especially upon contact with mucous membranes. While favored in certain cuisines around the world, it has also been weaponized in the form of pepper sprays and bear repellents. When significant capsaicin exposures occur, patients may present to the emergency department; thus, providers should be prepared to manage these cases effectively. In this case report we discuss an unusual exposure of capsaicin to the vaginal mucosa with successful treatment.
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Affiliation(s)
- Onur Yenigun
- Stanford University Medical Center, Department of Emergency Medicine, Palo Alto, California; Kaiser Permanente Medical Center, Department of Emergency Medicine, Santa Clara, California
| | - Mark Thanassi
- Kaiser Permanente Medical Center, Department of Emergency Medicine, Santa Clara, California
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Ilgaz A, Uyanusta FÇK, Arbak P, Müezzinoğlu A, Çiftçi TU, Akpınar S, Fırat H, Güven SF, Çiftçi B, Karaoğlanoğlu S, Dağlı E, Erkan F. Extensive Exposure to Tear Gases in Ankara. Turk Thorac J 2019; 20:108-113. [PMID: 30958982 DOI: 10.5152/turkthoracj.2018.18096] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 09/18/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVES The most common chemical substances used as mass control agents are chloroacetophenone, chlorobenzylidene malononitrile, and oleoresin capsicum. These agents not only have local and rapid effects but also have systemic and long-term effects. The aim of the present study was to discuss the patterns of tear gas exposure and to investigate its effects on respiratory functions. MATERIALS AND METHODS A face-to-face survey was conducted in 86 individuals who had been exposed to tear gas indoor and outdoor during the public protests in June 2013. RESULTS The most frequently reported respiratory complaints included cough, dyspnea, phlegm, and chest pain. Spirometry measurements including forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were also performed. Indoor exposers have lower mean % predicted FVC and FEV1 values than outdoor exposers. All complaints and signs were more common in indoor exposure to tear gas than in outdoor exposure. CONCLUSION Safety of the chemicals used as mass control agents during protests is doubtful as these agents are associated with several health risks.
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Affiliation(s)
- Aslıhan Ilgaz
- Clinic of Pulmonary Diseases, Middle East Technical University, Medical Center, Ankara, Turkey
| | | | - Peri Arbak
- Department of Chest Diseases, Düzce University School of Medicine, Düzce, Turkey
| | - Arif Müezzinoğlu
- Ankara Chamber of Medical Doctors, Commission of Workers' Health and Occupational Physicians, Ankara, Turkey
| | - Tansu Ulukavak Çiftçi
- Department of Pulmonary Diseases, Gazi University School of Medicine, Ankara, Turkey
| | - Serdar Akpınar
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Hikmet Fırat
- Clinic of Chest Diseases, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Selma Fırat Güven
- Sleep Disorders Center, Atatürk Chest Diseases, Thoracic Surgery Training and Research Hospital, Ankara, Turkey
| | - Bülent Çiftçi
- Department of Pulmonary Diseases, Bozok University School of Medicine, Yozgat, Turkey
| | - Selen Karaoğlanoğlu
- Department of Pulmonary Diseases, Ordu University School of Medicine, Ordu, Turkey
| | - Elif Dağlı
- Clinic of Child Chest Diseases, Acıbadem Fulya Hospital, İstanbul, Turkey
| | - Feyza Erkan
- Department of Pulmonary Medicine, İstanbul University İstanbul School of Medicine, İstanbul, Turkey
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Stopyra JP, Winslow JE, Johnson JC, Hill KD, Bozeman WP. Baby Shampoo to Relieve the Discomfort of Tear Gas and Pepper Spray Exposure: A Randomized Controlled Trial. West J Emerg Med 2018; 19:294-300. [PMID: 29560057 PMCID: PMC5851502 DOI: 10.5811/westjem.2017.12.36307] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Revised: 11/12/2017] [Accepted: 12/08/2017] [Indexed: 11/11/2022] Open
Abstract
Introduction Oleoresin capsicum (OC) or pepper spray, and tear gas (CS) are used by police and the military and produce severe discomfort. Some have proposed that washing with baby shampoo helps reduce this discomfort. Methods We conducted a prospective, randomized, controlled study to determine if baby shampoo is effective in reducing the severity and duration of these effects. Study subjects included volunteers undergoing OC or CS exposure as part of their police or military training. After standardized exposure to OC or CS all subjects were allowed to irrigate their eyes and skin ad lib with water. Those randomized to the intervention group were provided with baby shampoo for application to their head, neck, and face. Participants rated their subjective discomfort in two domains on a scale of 0–10 at 0, 3, 5, 10, and 15 minutes. We performed statistical analysis using a two-tailed Mann-Whitney Test. Results There were 58 participants. Of 40 subjects in the OC arm of the study, there were no significant differences in the ocular or respiratory discomfort at any of the time points between control (n=19) and intervention (n=21) groups. Of 18 subjects in the CS arm, there were no significant differences in the ocular or skin discomfort at any of the time points between control (n=8) and intervention (n=10) groups. Conclusion Irrigation with water and baby shampoo provides no better relief from OC- or CS-induced discomfort than irrigation with water alone.
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Affiliation(s)
- Jason P Stopyra
- Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - James E Winslow
- Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - James C Johnson
- Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - Keith D Hill
- Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
| | - William P Bozeman
- Wake Forest University School of Medicine, Department of Emergency Medicine, Winston-Salem, North Carolina
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Rothenberg C, Achanta S, Svendsen ER, Jordt SE. Tear gas: an epidemiological and mechanistic reassessment. Ann N Y Acad Sci 2016; 1378:96-107. [PMID: 27391380 PMCID: PMC5096012 DOI: 10.1111/nyas.13141] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/15/2016] [Accepted: 05/20/2016] [Indexed: 12/19/2022]
Abstract
Deployments of tear gas and pepper spray have rapidly increased worldwide. Large amounts of tear gas have been used in densely populated cities, including Cairo, Istanbul, Rio de Janeiro, Manama (Bahrain), and Hong Kong. In the United States, tear gas was used extensively during recent riots in Ferguson, Missouri. Whereas tear gas deployment systems have rapidly improved-with aerial drone systems tested and requested by law enforcement-epidemiological and mechanistic research have lagged behind and have received little attention. Case studies and recent epidemiological studies revealed that tear gas agents can cause lung, cutaneous, and ocular injuries, with individuals affected by chronic morbidities at high risk for complications. Mechanistic studies identified the ion channels TRPV1 and TRPA1 as targets of capsaicin in pepper spray, and of the tear gas agents chloroacetophenone, CS, and CR. TRPV1 and TRPA1 localize to pain-sensing peripheral sensory neurons and have been linked to acute and chronic pain, cough, asthma, lung injury, dermatitis, itch, and neurodegeneration. In animal models, transient receptor potential inhibitors show promising effects as potential countermeasures against tear gas injuries. On the basis of the available data, a reassessment of the health risks of tear gas exposures in the civilian population is advised, and development of new countermeasures is proposed.
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Affiliation(s)
- Craig Rothenberg
- Department of Global Environmental Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Satyanarayana Achanta
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Erik R Svendsen
- Division of Environmental Health, Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina
| | - Sven-Eric Jordt
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina.
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Exposure to the riot control agent CS and potential health effects: a systematic review of the evidence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 12:1397-411. [PMID: 25633030 PMCID: PMC4344673 DOI: 10.3390/ijerph120201397] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Accepted: 01/20/2015] [Indexed: 11/16/2022]
Abstract
o-Chlorobenzylidene malononitrile (CS) is one of the most extensively used riot control agents. Our aim was to conduct a systematic review of the potential health effects related to CS exposure. We searched for papers in English between 1991 and 2014. Thirty five (35) studies (25 case reports, seven descriptive studies and three analytical studies) were included in the review. In the twenty five case reports/series 90 cases of exposure to CS and their clinical effects are presented. Their mean age was 25.7 years and 62.0% were males. In addition, 61% of the cases described dermal, 40% respiratory, 57% ocular clinical effects. Life threatening situations as well as long-term health effects were found and were related with exposure to confined/enclosed space. Descriptive and analytical studies have shown attack rates ranging from 12% to 40%. Subjects who were sprayed by the police more often needed special treatment and reported adverse health effects. Apart from transient clinical effects, CS could have lasting and serious effects on human health. Better surveillance of the subjects exposed to CS and completion of cohort studies among exposed populations will illuminate the spectrum of the health effects of exposure to CS.
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Schep LJ, Slaughter RJ, McBride DI. Riot control agents: the tear gases CN, CS and OC-a medical review. J ROY ARMY MED CORPS 2013; 161:94-9. [PMID: 24379300 DOI: 10.1136/jramc-2013-000165] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 11/25/2013] [Indexed: 11/04/2022]
Abstract
INTRODUCTION 2-Chloroacetophenone (CN), o-chlorobenzylidene malonitrile (CS) and oleoresin capsicum (OC) are common riot control agents. While serious systemic effects are uncommon, exposure to high concentrations may lead to severe complications and even death. The aim of this narrative review is to summarise all main aspects of the riot control agents CN, CS and OC toxicology, including mechanisms of toxicity, clinical features and management. METHODS OVID MEDLINE and ISI Web of Science were searched for terms associated with CN, CS and OC toxicity in humans and those describing the mechanism of action, clinical features and treatment protocols. RESULTS CN, CS and OC are effective lacrimating agents; evidence for toxicity, as measured by the threshold for irritation, is greatest for CN, followed by CS and OC. Typically, ocular and respiratory tract irritation occurs within 20-60 s of exposure. Ocular effects involve blepharospasm, photophobia, conjunctivitis and periorbital oedema. Following inhalation, effects may include a stinging or burning sensation in the nose, tight chest, sore throat, coughing, dyspnoea and difficulty breathing. Dermal outcomes are variable, more severe for CN and include dermal irritation, bulla formation and subcutaneous oedema. Removal from the contaminated area and fresh air is a priority. There is no antidote; treatment consists of thorough decontamination and symptom-directed supportive care. Ocular exposure requires thorough eye decontamination, an eye exam and appropriate pain management. Monitoring and support of respiratory function is important in patients with significant respiratory symptoms. Standard treatment protocols may be required with patients with pre-existing respiratory conditions. Dermal exposures may require systemic steroids for patients who develop delayed contact dermatitis. CONCLUSIONS CN, CS and OC are effective riot control agents. In the majority of exposures, significant clinical effects are not anticipated. The irritant effects can be minimised both by rapid evacuation from sites of exposure, decontamination and appropriate supportive care.
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Affiliation(s)
- Leo J Schep
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - R J Slaughter
- National Poisons Centre, Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - D I McBride
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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Pesonen M, Vähäkangas K, Halme M, Vanninen P, Seulanto H, Hemmilä M, Pasanen M, Kuitunen T. Capsaicinoids, chloropicrin and sulfur mustard: possibilities for exposure biomarkers. Front Pharmacol 2010; 1:140. [PMID: 21833179 PMCID: PMC3153014 DOI: 10.3389/fphar.2010.00140] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2010] [Accepted: 06/11/2010] [Indexed: 01/05/2023] Open
Abstract
Incapacitating and irritating agents produce temporary disability persisting for hours to days after the exposure. One can be exposed to these agents occupationally in industrial or other working environments. Also general public can be exposed in special circumstances, like industrial accidents or riots. Incapacitating and irritating agents discussed in this review are chloropicrin and capsaicinoids. In addition, we include sulfur mustard, which is an old chemical warfare agent and known to cause severe long-lasting injuries or even death. Chloropicrin that was used as a warfare agent in the World War I is currently used mainly as a pesticide. Capsaicinoids, components of hot pepper plants, are used by police and other law enforcement personnel as riot control agents. Toxicity of these chemicals is associated particularly with the respiratory tract, eyes, and skin. Their acute effects are relatively well known but the knowledge of putative long-term effects is almost non-existent. Also, mechanisms of effects at cellular level are not fully understood. There is a need for further research to get better idea of health risks, particularly of long-term and low-level exposures to these chemicals. For this, exposure biomarkers are essential. Validated exposure biomarkers for capsaicinoids, chloropicrin, and sulfur mustard do not exist so far. Metabolites and macromolecular adducts have been suggested biomarkers for sulfur mustard and these can already be measured qualitatively, but quantitative biomarkers await further development and validation. The purpose of this review is, based on the existing mechanistic and toxicokinetic information, to shed light on the possibilities for developing biomarkers for exposure biomonitoring of these compounds. It is also of interest to find ideas for early effect biomarkers considering the need for studies on subchronic and chronic toxicity.
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Affiliation(s)
- Maija Pesonen
- Faculty of Health Sciences, School of Pharmacy, University of Eastern Finland, Kuopio, Finland
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Agrawal Y, Thornton D, Phipps A. CS gas—Completely safe? A burn case report and literature review. Burns 2009; 35:895-7. [DOI: 10.1016/j.burns.2008.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2007] [Accepted: 06/30/2008] [Indexed: 11/12/2022]
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Abstract
We report on an unusual exposure to o-chlorobenzylidene malononitrile (CS agent) following its use to detect unauthorized stowaways aboard a vehicle, and the subsequent handling of the cargo delivered to retail stores across Scotland. Twenty-one staff in 16 retail stores across Scotland experienced symptoms including itching and running eyes, rhinorhoea, a burning sensation on the face and hands, and a burning throat, following the furniture deliveries. A survey was conducted to assess the extent of exposure to the contaminated furniture and the scale of illness associated with exposure. Experiencing symptoms was significantly associated with having contact with the furniture or packaging (chi(2) = 10.5, p < 0.001). This incident demonstrates the risk of inadvertent secondary exposure and subsequent acute symptoms from contact with residual CS agent when sprayed in the confined spaces of haulage vehicles.
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Affiliation(s)
- Steven M Hankin
- Health Protection Scotland, Clifton House, Clifton Place, Glasgow, UK.
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