According to some people, the first of these sentences is perfectly fine, while the second has a common but nevertheless gutting mistake in it:
(1a) His romp through the woods was pleasant enough, but ending up in poison oak again aggravated his rash.
(1b) The constant itching over the next week left him quite aggravated.
That’s because these people believe that aggravate to mean “irritate” or “annoy” is a newfangled and improper meaning. To them, aggravate has but one meaning, and that is its earlier meaning of “to worsen”.
However, it turns out that neither of these are the original meaning of aggravate, which was “to make heavier”. In fact, this was the meaning with which aggravate was borrowed into English from Latin in the 15th century. That meaning has been all but lost in contemporary English — one can’t say “I aggravated the pick-up with my moving boxes” and expect people to make sense of that. So if you think you’re defending aggravate by sticking to its original usage, you’re doubly wrong.
Well, you might say, the “worsen” meaning is old enough, and the “irritate” meaning is still pretty new, so that’s why I’m against it. But that argument doesn’t hold water either; the first attestation of the “irritate” meaning in the Oxford English Dictionary is all the way back in 1611, only 15 years after the first “worsen” attestation.
The “irritate” meaning is a metaphorical extension of the original meaning; “make heavier” gets metaphorically extended to “add mental burdens” (think of other weight/thought/concern metaphors such as “weigh heavily on one’s mind”, “heavy thinking”, “weighing options”, etc.). From there it’s only a short hop to “irritate”, and we made it.
There’s no real loss in doing this. No significant ambiguity is gained by having these two meanings of aggravate. One can’t irritate an inanimate object, so (1a) is clearly using the “worsen” meaning. One can’t worsen a person, so (1b) is clearly using the “irritate” meaning.
The antarctic explorer aggravated the sled with his heavy supplies, which had aggravated his shoulder injury, which had aggravated him.
There’re a few other complaints I’ve heard about the “irritate” meaning of aggravate. One is that there are too many words to mean “irritate” and not enough to mean “worsen”. But that presumes that the “irritate” meaning is eliminating the “worsen” meaning, and I don’t think that’s the case. Anyone who follows sports is familiar with the crushing feeling of their favorite player aggravating their existing injuries. Is this meaning losing ground? Probably. Might it disappear eventually, leaving behind only idioms like “aggravated assault”? Possibly, but that’s what language does. Why isn’t anyone shedding tears over the loss of a good word meaning “to make heavier”?
Another occasional argument I see is that aggravate meaning “irritate” is “less precise”, and I’m not really clear on what that’s supposed to mean. Less precise than using irritate? Irritate can also mean “inflame” (as in eye irritant) and has an obscure legal meaning of “make void”. The example I always give for how this “imprecision” problem is not a problem is mean. The word mean can mean so many things (average, grouchy, etc.), and yet we somehow encounter no problems from this lack of precision. In fact, the imprecision of language can be beneficial; compare your imprecise conversations with your friends to the precise language of your favorite legal contract.
The final objection is that aggravate meaning “irritate” is informal. (Jan Freeman discussed this in her column on aggravate.) This may have been the case at some point, but I am unconvinced that it is currently true. The Corpus of Contemporary American English provides various examples of this usage in modern formal academic writing, and Google Books can provide formal usages back into the 19th century. I suspect that the perceived informality is due the tendency of discussions of one’s feelings to be informal.
Summary: The “irritate” meaning of aggravate dates back to the 1600s, and it doesn’t interfere with the “worsen” meaning of aggravate. Neither is the original meaning of aggravate, either. There’s just no good reason to object to the “irritate” meaning.
Motivated Grammar 
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June 23, 2011 at 10:05 am
Carolyn
Using aggravated to mean annoyed or irritated fits in one of my dialects, and not the other. I’ll understand it, but I won’t use it that way–unless I happen to be in the South. I’d admit to being aggravated by Atlanta’s traffic, but not by Boston’s.
June 23, 2011 at 11:13 am
Jan Freeman
Gabe, thanks for linking to my column. I think my favorite discovery from researching “aggravate” was the fact that EVEN IN LATIN “aggravare” was used to mean “vex, oppress.” The English usage mavens were quite aggravated by that …
June 23, 2011 at 12:33 pm
Jonathon
I’m just speaking for myself here, but I think there may still be some interference between the “make worsen” and “irritate” meanings of aggravate. It took me years to figure out that “aggravated assault” did not mean “irritated assault”, but rather “assault that is made worse”.
Also, if the “irritate” sense is still less formal or less standard than the “make worsen” sense, I think it’s only because copy editors and English teachers are keeping it out of edited and educated writing.
June 24, 2011 at 6:39 pm
Dan M.
Thanks, Carolyn; that’s really interesting to know.
June 25, 2011 at 8:05 am
Abbie
Similarly, I used to think “aggravated assault” was assault carried out in response to being very irritated/aggravated.
June 26, 2011 at 11:28 pm
Jordy
How about this quote, which aggravates me?
Yet she became more and more promiscuous as she recalled the days of her youth, when she was a prostitute in Egypt. There she lusted after her lovers, whose genitals were like those of donkeys and whose emission was like that of horses.
— Ezekiel 23:19-20
July 5, 2011 at 4:23 pm
Gabe
Carolyn: Wow, that’s really interesting. Do you have any feeling for whether this distinction is that you speak more formally about Boston or if it’s just a distinction between two equally formal dialects?
Jan Freeman: Ah, the master herself! Yes, that really was an amazing point, and one that I meant to work in but failed to find a good spot for. Thanks for bringing it up, and for writing the column in the first place!
Jonathon/Abbie: Yes, I may have oversold their separability a bit, especially since I made the same mistake as you when I was younger. They can be confused in certain situations, but I feel like in those situations the difference in meaning is relatively small; even when I misunderstood “aggravated assault”, it was still clear that “aggravated” made it somehow worse than regular assault.
May 7, 2012 at 1:26 pm
kitchenmudge
How about redundancy, as an objection? Since “aggravate” in the “irritate” sense means exactly the same as “irritate”, why not just say “irritate”, so there’s no ambiguity?
I suspect this “aggravate” for “irritate” became popular as a vaudeville malapropism, repeated by those who didn’t know it was a malapropism.
May 7, 2012 at 3:02 pm
kitchenmudge
By the way, “aggravate” in the “irritate” sense has definitely pushed out the “make worse” meaning. It’s why “aggravate” is rarely heard at all these days, and has been replaced with that monstrosity “exacerbate”, as I pointed out here:
May 8, 2012 at 11:51 am
Gabe
kitchenmudge: I’m of the opinion that no two words mean exactly the same thing; whether there’s a subtle difference in meaning, intensity, connotation, formality, or something else. For me, irritate is weaker than aggravate, so the presence of both of them isn’t redundant. Anyway, language is redundant all over the place. The existence of thesauruses illustrates that there’s nothing unnatural about (near-)synonyms.
September 9, 2012 at 12:17 pm
Daniel
Shouldn’t the original meaning “to make heavier” suggest to burden or make worse? That’s what I’m thinking.
March 11, 2014 at 4:53 am
Lara
I’d love to read how you would address nauseous/nauseated…. My recent pet peeve.
Thank you,
Thanks!