An enzyme reaction may begin to decline when the pH of the medium is altered. Enzymes are biological catalysts that speed up chemical reactions in living organisms. Each enzyme has an optimum range of pH and temperature at which it functions best. Any deviation from this optimal range can cause the enzyme to become denatured, which means that the shape of the enzyme is changed and it can no longer catalyze the reaction. Changes in pH can alter the charges on the amino acids that make up the enzyme, which can affect the shape of the enzyme and its ability to bind to the substrate. Therefore, if the pH of the medium is altered, the enzyme reaction may begin to decline as the enzyme becomes denatured and is no longer able to catalyze the reaction. Based on the given options, the correct answer is the pH of the medium is altered.