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Epinephrine is the first-line treatment for anaphylactic reactions due to its potent vasoconstrictive and bronchodilatory effects. Anaphylaxis is a severe, life-threatening allergic reaction that can occur rapidly after exposure to an allergen. The administration of epinephrine works by constricting blood vessels, which increases blood pressure and improves perfusion to vital organs, addressing one of the critical aspects of anaphylaxis – hypotension. It also acts on β-adrenergic receptors in the lungs, causing bronchodilation, which alleviates airway obstruction and difficulty in breathing that often accompanies anaphylaxis.

Other medications listed are not suitable for immediate treatment of anaphylaxis. While ibuprofen is an anti-inflammatory medication, it does not provide the rapid response needed in anaphylactic situations. Insulin is used primarily in the management of diabetes and would not address the acute, life-threatening symptoms of anaphylaxis. Prednisone, a corticosteroid, may be used for its anti-inflammatory effects in managing allergic reactions but takes hours to days to exert its action and is not appropriate for immediate treatment in acute anaphylaxis. Therefore, the most effective and commonly administered medication in this emergency situation is epinephrine.