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    High digit ratio (2D:4D) is associated with attack frequency and severity in hereditary angioedema patients
    (Elsevier Ireland Ltd, 2023) Evcen, Recep; Colkesen, Fatih; Saygin, Duygu Akin; Aykan, Filiz Sadi; Kilinc, Mehmet; Ergun, Ummugulsum Yilmaz; Akkus, Fatma Arzu
    Background: Hereditary angioedema (HAE) caused by a deficiency or dysfunction of the plasma protease C1inhibitor is a rare autosomal-dominant disorder. We explored a possible correlation between the ratio of the second and fourth finger lengths (2D:4D) and the frequency of HEA attacks, and whether the ratio might predict laryngeal attack. Method: We evaluated 35 HEA patients aged 19 to 66 years; 3 were subsequently excluded. The 2D:4D ratio was calculated by dividing the length of the second finger by that of the fourth finger of both hands. A structured clinical questionnaire exploring HAE course and treatment over the prior year was administered.Results: Of the 32 participants, 56.25 % (n = 18) were female. Of them, those with high 2D:4D ratios suffered significantly more laryngeal attacks than others; 93.3% of patients with high 2D:4D ratios experienced >= 5 attacks annually, significantly more than those with low ratios. Among type 2 HEA patients, 75 % of those experiencing >= 5 attacks annually had high 2D:4D ratios; all patients with low 2D:4D ratios reported <5 attacks annually. These significant effects were found for right-hand 2D:4D ratios and not left-hand 2D:4D ratios.Conclusion: The data suggest that intrauterine sex hormone exposure, which affects the 2D:4D ratio, is significantly associated with HEA attack frequency and severity, and laryngeal edema.