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Here's the mechanism: the enzyme ALDH2 (aldehyde dehydrogenase 2) oxidises acetaldehyde into acetic acid, but this process requires adequate glutathione reserves to neutralise reactive oxygen species (ROS) generated during the reaction

DOI: 10.1210/jc.2005-1468 (PMID: 16174713) George, J.T., et al

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This is not due to changes in KLOWs intrinsic stability but rather saturation kinetics in the kidneys the elimination pathway becomes backlogged, delaying complete clearance proportionally to the administered dose

These medications are not a requirement for each and every individual