A 4-year-old girl presented to the paediatric A&E with her mother and grandmother. Her mother recounted that she had developed facial swelling following a spider bite 2 weeks previously. Prior to the onset of facial swelling, she had seen her GP a week before for new onset noisy breathing. The GP noted normal blood pressure, normal urine dipstick but mild stridor. A short course of prednisolone was prescribed for mild croup and the stridor resolved. A week later the spider bite occurred with worsening associated facial swelling over the next 2 weeks and the stridor recurred. Mother noted the stridor was mainly at night, to the extent that the child found it difficult to lie flat. She was also generally tired but had no other abnormal history.