Y Yeşilova, et al 2007 and April 2008. All children met the diagnostic criteria for AD as defined by Hanifin and Rajka5. The inclusion criteria were: a moderate to severe Scoring Atopic Dermatitis (SCORAD) index score6,7; being 1∼13 years of age; absence of any other disease; having used no medication including antihistamines and corticosteroids for fourteen days prior to the study; and absence of gastrointestinal malabsorption. Patients were referred to a nurse who was involved in the study to receive either probiotics or placebo. The nurse randomized each patient to two different treatment groups using the closed-envelope method. The authors had no role in the treatment decision and were blinded to the treatment groups. In this randomized double-blind, placebo-controlled study, patients were assigned to one of two groups, probiotics (Group 1) or placebo (Group 2). Group 1 (n=20) received two bags containing 2×109 of four types of probiotic bacteria (Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lacto- bacillus salivarius) made by a commercially available supplementation (proBiotikⓇ pur, Ella Farma, Münster, Germany), while those in Group 2 (n=20) received skim milk powder (Dairy Inc., Enka Milk Joint Stock Company, Turkey) and dextrose (Havana Chemistry, Pharmaceutical Medical Limited Company, Istanbul, Turkey) daily for a total of eight weeks. Blood samples collected at baseline and ten weeks later were followed by storing plasma frozen at −80oC until all cytokine analyses were performed. Total immunoglobulin E (IgE) levels were analyzed using total and 3gAllergyTM assays (Immulite 2,000 Immunoassay System, Siemens Healthcare Diagnostics, Siemens Healthcare Diagnostics Inc., Deerfield, IL, USA), following the manufacturer’s instructions. Eosinophil cationic protein (ECP) and cytokine levels were determined using enzyme-linked immunosorbent assay (BioSource International, Inc., Ca- marillo, CA, USA) using a Triturus® System (Grifols Inter- national S.A., manufactured by Grifols-Quest Inc.). The study protocol followed the Declaration of Helsinki and included written consent by the parents or guardians of the participating patients. The study was approved by the Drug Research Ethics Committee and was supported by the Scientific Research Projects. Statistical analysis All analyses were conducted using SPSS 11.5 statistical program (SPSS Inc., Chicago, IL, USA). A ratio test was applied to compare the proportion of patients in groups by age and sex. Pre- and post-treatment differences of serum cytokines, total IgE levels, ECP, and changes in SCORAD indices were compared using a paired t-test. p-values ＜0.01 were considered statistically significant. RESULTS One female patient in the placebo group failed to attend her follow-up visits resulting in withdrawal from the study. Comprising 58.9% of the patients, 23 males (aged 1∼12 years, mean [standard deviation, SD] 7.6±3) and 16 females (aged 1∼13 years, mean [SD] 9.3±3.2) com- pleted the study. The SCORAD index changed from 35.4±13.4 to 12.4±7.2 and from 28.1±6.1 to 15.3±5.1 in the pro- biotic and placebo groups, respectively. The post- treat- ment decrease in the SCORAD index in the probiotic group was greater than the decrease in the placebo group, Table 1. Changes in the levels of serum cytokines, SCORAD index, and total serum IgE levels and comparisons before and after probiotic and placebo administration Parameters IL-2 (pg/ml) IL-4 (pg/ml) IL-5 (pg/ml) IL-6 (pg/ml) IL-10 (pg/ml) TNF-α (pg/ml) IFN-γ (pg/ml) ECP (ng/ml) SCORAD index Serum total IgE (IU/ml) 190 Ann Dermatol BT mean±SD of probiotic group (n=20) 42.21±20.77 31.34±27.96 53.60±54.90 21.40±64.90 18.21±10.41 32.90±24.06 16.52±15.37 20.42±20.29 35.4±13.4 427±500 AT mean±SD of probiotic group (n=20) 29.83±14.05 25.12±15.16 35.97±28.57 5.26±4.99 17.15±8.51 29.55±19.06 15.40±16.20 18.24±20.22 12.4±7.2 281.9±405 BT mean±SD of placebo group (n=20) 32.25±15.59 19.51±17.75 28.47±29.90 4.00±5.18 14.30±9.54 22.95±22.58 13.95±9.48 19.72±21.11 28.1±6.1 337.3±298 AT mean±SD of placebo group (n=20) 28.46±21.36 19.51±17.75 30.53±27.25 6.56±11.61 18.02±10.95 22.81±22.26 27.45±28.53 21.87±21.45 15.3±5.1 347.7±271.3 p- value* 0.023 0.67 0.0012 0.0016 0.013 0.437 0.0011 0.021 0.0015 0.0035 SCORAD: SCORing Atoptic Dermatitis, BT: before treatment, SD: standard deviation, AT: after treatment, IL-2: interleukin-2, IL-4: interleukin-4, IL-5: interleukin-5, IL-6: interleukin-6, IL-10: interleukin-10, TNF-α: tumor necrosis factor-α, IFN-γ: interferon-γ, ECP: eosinophil cationic protein, IgE: immunoglobulin E. *Statistical used paired t-test for testing. p values＜0.05 were considered statistically significant.