Roessler 2007.

Methods	Twenty‐week cross‐over randomised double‐blind placebo‐controlled trial
Participants	Sixteen adults between 18 and 40 years of age with eczema diagnosed based on Erlangen score > 10 (atopic score of Diepgen) and SCORAD severity score 5 to 30 were recruited. Only patients who were willing to apply cosmetic products and the Class II topical corticosteroid Advantan were recruited. Exclusion criteria were disease necessitating medication with systemic corticosteroids, immunosuppression, or cytostatics within 4 weeks before the start of the study; phototherapy or systemic treatments within 4 weeks before the start of the study; long‐acting antihistamines, antibiotics, long‐term systemic corticosteroids, depot steroids, tranquillisers, and psychopharmaceuticals with antihistamine effect or within 7 days from skin prick test; or astemizole intake within 4 weeks before prick testing. Also excluded were patients with active skin infection; asthma needing treatment with corticosteroids; indigestibility/allergy to milk components (including skin prick test); lactose intolerance; acute or chronic symptomatic heart disease or severe internistic disease; autoimmune disease; immune deficiency (including immune suppressive treatment); immune complex‐induced immunopathy or malignant tumour; or abuse of alcohol, drugs, or medicaments, as well as pregnant and breastfeeding women Recruitment was done at a secondary care centre in Germany One participant withdrew after randomisation and before treatment started
Interventions	Probiotic yoghurt drink containing Streptococcus thermophilus enriched with Lactobacillus paracasei Lpc‐37 (3.9 × 10⁸ CFUs/g), Lactobacillus acidophilus 74‐2 (2.9 × 10⁴ CFUs/g), Bifidobacterium lactis DGCC 420 (5.9 × 10⁴ CFUs/g) taken as 100 mL twice daily for 8 weeks Total daily dose was Lpc‐37: 7.8 × 10¹º CFUs/d, 74‐2: 5.8 × 10⁶ CFUs/d, and DGCC 420: 1.2 × 10⁷ CFUs/d Placebo drink not otherwise specified given as 100 mL twice daily Crossing over from one to the other intervention involved a washout period of 2 weeks Instructions were given for elimination of other probiotic and prebiotic products for 3 weeks before the start of treatment and during the 20 weeks of intervention
Outcomes	Total SCORAD and SCORAD part C at baseline and after 8 weeks of each intervention* *Denotes outcomes prespecified for this review
Notes	Study was sponsored by a grant from Zott Dairy GmbH (not the probiotic supplier). It was declared that Zott had no involvement in study design, data analysis, and publication, and study authors declared no conflict of interest
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Quote: "all subjects were randomly assigned to 2 treatment groups (1:1) according to a computer generated blocked randomisation list (blocked randomisation)" Comment: judged as adequate for low risk of bias
Allocation concealment (selection bias)	Unclear risk	Comment: not clear whether treatment allocation was concealed
Blinding of participants and personnel (performance bias) All outcomes	Low risk	Quote: "The placebo drink had an identical composition except for the probiotic cultures and had the same appearance, taste and smell as the probiotic drink" ‐ "Enrollment and assignment to interventions were performed by the trial physician and AR. All involved persons (trial physician and scientific staff) were blinded. In addition study products were blinded and labelled with a numerical code by the production dairy" Comment: judged as adequate for low risk of bias
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Quote: "The placebo drink had an identical composition except for the probiotic cultures and had the same appearance, taste and smell as the probiotic drink" ‐ "Enrollment and assignment to interventions were performed by the trial physician and AR. All involved persons (trial physician and scientific staff) were blinded. In addition study products were blinded and labelled with a numerical code by the production dairy" Comment: judged as adequate for low risk of bias
Incomplete outcome data (attrition bias) All outcomes	Low risk	One participant (6.6%) withdrew after randomisation and before the start of treatment and was excluded from analysis. All other participants were analysed in the group to which they had been randomised. Low rates of loss to follow‐up were unlikely to have a significant influence on effect estimates
Selective reporting (reporting bias)	Low risk	All outcomes reported
Other bias	Low risk	No other bias found