In Linux, I used to use the following command, which takes audio input, applies reverb and a pitch shift effects, and then outputs the result to the specified audio device.
sox -r 44100 -t alsa hw:1 -t alsa hw:0 reverb 1 50 10 50 pitch 100
On mac/OSX, I have installed the commandline audio utility sox, and I can record OR play audio using -d (default audio device), but I'm unable to get sox to do the same real-time audio manipulation that I did in Linux shown above. I think the key is finding out what to specify for the -t option